1904株革兰阴性杆菌耐药性检测

目的 :了解临床分离的革兰阴性杆菌耐药状况及耐药性变迁。方法 :1997年 1月至 2 0 0 3年 12月临床分离革兰阴性杆菌 190 4株 ,排除同一患者的重复菌株 ,按统一方案用Kirby Bauer法进行药敏试验 ,按美国国家临床实验室标准委员会2 0 0 0年版标准判读结果。结果 :多数年份革兰阴性杆菌对氨苄西林耐药率高达 80 %以上。大肠埃希菌对哌拉西林、喹诺酮类耐药率为 5 0 %左右 ,对第三代头孢菌素、阿米卡星耐药率逐步上升 ,1997、2 0 0 0、2 0 0 3各年相比 ,P <0 .0 5 ,差异有显著性 ,未见亚胺培南耐药株。克雷伯菌属对哌拉西林、第三代头孢菌素、喹诺酮类耐药率增加迅速 ,1997、2 0 0 0、2 0 0 3各年相比 ,P <0 .0 5。铜绿假单胞菌对哌拉西林、头孢哌酮耐药率上升明显 ,在 2 0 0 3年对头孢哌酮、头孢他啶耐药率为 2 6 .2 %、16 .4 %。对亚胺培南耐药率为 6 %。不动杆菌属对第三代头孢菌素的耐药率为 70 % ,对亚胺培南耐药率为 10 .3%。嗜麦芽窄食单胞菌对氨苄西林、头孢曲松、氨曲南、亚胺培南、庆大霉素和阿米卡星耐药率极高 ,仅对环丙沙星和复方磺胺甲唑耐药率较低。结论 :近年来革兰阴性杆菌的耐药性呈上升趋势 ,特别是对第三代头孢菌素耐药性上升最快 ,亚胺培南仍是目前对革兰阴性杆菌最有效的药物。

Surveillance on antimicrobial resistance of 1 904 strains of gram-negative bacilli

Objective: To investigate the antimicrobial resistance of clinical isolates of gram-negative bacilli. Methods:Antimicrobial susceptibility testing was done on 1 904 strains of gram-negative bacilli isolated in our hospital from January 1997 to December 2003 by Kirby-Bauer method. Results were assessed according to NCCLS 2000. Results:The resistance rates of most gram-negative bacilli to ampicillin were more than 80%. The resistance rates of Escherichia coli to piperacillin and fluoroquinolones were approximately 50.0%, the resistance rates to the third-generation cephalosporins and amikacin from 1997 to 2000 increased significantly and compared with those figures from 2000 to 2003 (P<0.05); no strain resistant to imipenem was found. Resistant rates of Klebsiella spp. to piperacillin, the third-generation cephalosporins and fluoroquinolones from 1997 to 2000 increased markedly compared with the figures from 2000 to 2003 (P<0.05). The resistance rates of Pseudomonas aeruginosa to piperacillin, cefoperazone and ceftazidime increased rapidly being 26.2% and 16.4 % to cefoperazone and ceftazidime, respectively, in 2003. The resistance rate to imipenem was 6%. The resistance rates of Acinetobacter spp. to the third-generation cephalosporins were higher than 70%, being 10.3% to imipenem.Strains of Stenotrophomonas maltophilia were highly resistant to ampicillin, ceftriaxone, aztreonam, imipenem, gentamicin and amikacin, however ciprofloxacin and trimethoprim-sulfamethoxazole have better activity against these strains. Conclusions:The resistance rates of gram-negative bacilli to antimicrobials especially to the third-generation cephalosporins, increased markedly, in recent years. Imipenem still has the highest activity against gram-negative bacilli.