重症监护病房最常见革兰阴性杆菌的耐药变迁

论　著

重症监护病房最常见革兰阴性杆菌的耐药变迁

张小江,王　辉,徐英春,谢秀丽,陈民钧

(北京协和医院,北京100730)

摘要:目的　调查我院重症监护病房(ICU)常见革兰阴性杆菌的耐药变迁。方法　从2000～2003年我院ICU病房分离到497株革兰阴性杆菌,采用E试验方法检测亚胺培南等11种抗菌药物对最常见菌株的最低抑菌浓度

(MIC),用WHONET25软件分析数据。结果　4年中常见革兰阴性杆菌为大肠埃希菌(20.3%)、铜绿假单胞菌(18.1%)、鲍氏不动杆菌(16.9%);4年中总敏感率最高的是亚胺培南(79%),其次是头孢哌酮/舒巴坦和哌拉西林/他

唑巴坦(均为67%),再次为头孢他啶(66%)、阿米卡星(65%)和头孢吡肟(62%);呼吸道标本最常见的是铜绿假单胞菌(27%)、鲍氏不动杆菌(22%),血、尿标本最常见均的是大肠埃希菌(33%、57%);对大肠埃希菌和鲍氏不动杆菌抗菌活性最强的是亚胺培南,且历年不减;2003年铜绿假单胞菌对阿米卡星和头孢他啶的敏感性为91.

3%;大肠埃希菌和肺炎克雷伯菌超广谱β2内酰胺酶(ESBLs)的发生率从2000年的29%和25%升高到2003年的68%和67%。结论　亚胺培南对大肠埃希菌和鲍氏不动杆菌均保持很高的敏感性,铜绿假单胞菌对阿米卡星和

头孢他啶敏感性最高,其他抗生素的活性在降低。关键词:革兰阴性杆菌;耐药监测;抗药性;微生物

中图分类号:R378.99　　文献标识码:A　　文章编号:100524529(2004)1021179204

ChangesofAntimicrobialResistanceamongMostCommonlyEncountered

Gram2negativeBacilliIsolatedfromIntensiveCareUnitsofPekingUnionMedicalCollegeHospital:YearsResultsin200022003

ZHANGXiao2jiang,WANGHui,XUYing2chun,XIEXiu2li,CHENMin2jun

(PekingUnionMedicalCollegeHospital,Beijing100730,China)

Abstract:OBJECTIVEToinvestigatethechangesofantimicrobialresistanceamongthemostcommonlyencounteredGram2negativebacilliisolatedfromintensivecareunits(ICU)ofPekingUnionMedicalCollegeHospitalduringthepast4years.METHODSFrom2000to2003,theminimalinhibitoryconcentrations(MIC)ofimipenemandothertenantibioticsfor497strains(includingthemostcommonlyencountered275strains)ofGram2negativebacilliisolatedfromICUinourhospitalweredeterminedbyEtest.WHONET25softwarewasusedtoanalyzethedata.RESULTSThemostcommonlyencounteredGram2negativebacilliwereEscherichiacoli(20.3%),Pseudomonasaeruginosa(18.1%)andAcinetobacterbaumannii(16.9%).TheantibioticremainingthemostactiveagainstalloftheGram2negativebacillifor4yearswasimipenem(79%),ThemostcommonlyencounteredpathogensinrespiratorytractspecimenswereP.aeruginosa(27%)andA.baumannii(22%).butinbloodandurinespecimenswasE.coli.TheantibioticremainingthemostactiveagainsttoE.coliandA.baumanniifor4yearswasimipenem.ThesusceptibilityrateofP.aeruginosatoamikacinandceftazidimewas91.3%in2003.Theprevalenceofextendedspectrumβ2lactamasesinE.coliandKlebsiellapneumoniaeincreasedfrom29%and25%in2000to68%and67%in2003.CONCLUSIONSImipenemremainshighlyactiveagainsttoE.coliandA.baumannii,amikacinandceftazidimehavethebestantibacterialactiveagainsttoP.aeruginosa,buttheactivitiesofotherantibioticshavedecreasedinpast4years.

Keywords:Gram2negativebacilli;Resistancesurveillance;Drugresistance;Microbes

　　我们自2000～2003年对我院ICU病房的各种感染患者中分离的497株革兰阴性杆菌进行耐药监

收稿日期:2004202210;　修回日期:2004206230

测,了解我院ICU病房革兰阴性杆菌的耐药变迁。

现将最常见革兰阴性杆菌的耐药监测结果及大肠埃希菌和肺炎克雷伯菌ESBLs的产生率报告如下。