Ho M, McDonald L C, Lauderdale T L, Yeh L L, Chen P C, Shiau Y R
Division of Clinical Research, National Health Research Institutes, Taipei, Taiwan, ROC.
J Microbiol Immunol Infect. 1999 Dec;32(4):239-49.
For the first national surveillance of antibiotic resistance in Taiwan, we collected in 1998 from 22 hospitals (6 medical centers, 15 regional hospitals, and 1 local hospital) 3,211 isolates in all parts of the country. Besides 50 random successive isolates from inpatients, each hospital was requested to collect 25 isolates each from positive blood cultures, hospital-acquired infections, outpatients and the pediatric department. We re-speciated all the submitted specimens and determined their antibiotic susceptibility patterns. The most common isolates were Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae), Staphylococcus aureus, and Pseudomonas aeruginosa. Among hospital-acquired infections, Acinetobacter spp. were among those which accounted for over 10% of the isolates. The oxacillin resistance of S. aureus was 82% in isolates from hospital-acquired infections, and 40% from outpatients. Among Enterococcus spp., 85% were either E. faecalis or E. faecium. They were 14% resistant to vancomycin. Among gram-negative bacteria, K. pneumoniae and Acinetobacter baumanii were hospital-acquired isolates that were most clearly more resistant than community acquired isolates. This difference was less apparent in the case of Enterobacter cloacae, Serratia marcescens, and P. aeruginosa. These bacteria were generally more resistant from all sources. Fifty-one percent of Salmonella were resistant to ampicillin; however, these were all sensitive to ciprofloxacin. Isolates from the East were least resistant. Plotting the disc zone diameters of antibiotics within the susceptible range, we identified subpopulations with smaller diameters in the case of vancomycin against S. aureus, ciprofloxacin against E. coli, and ciprofloxacin against Salmonella spp. These findings represent one of the purposes of this surveillance as they may portend developing resistances which bear careful watching in the future.
为进行台湾首次全国性抗生素耐药性监测，我们于1998年从22家医院（6家医学中心、15家地区医院和1家当地医院）收集了来自全国各地的3211株分离菌。除了从住院患者中随机连续收集50株分离菌外，还要求每家医院分别从阳性血培养、医院获得性感染、门诊患者和儿科收集25株分离菌。我们对所有提交的标本重新进行了菌种鉴定，并确定了它们的抗生素敏感性模式。最常见的分离菌是肠杆菌科细菌（大肠杆菌、肺炎克雷伯菌）、金黄色葡萄球菌和铜绿假单胞菌。在医院获得性感染中，不动杆菌属占分离菌的比例超过10%。医院获得性感染分离株中金黄色葡萄球菌对苯唑西林的耐药率为82%，门诊患者分离株的耐药率为40%。在肠球菌属中，85%为粪肠球菌或屎肠球菌。它们对万古霉素的耐药率为14%。在革兰氏阴性菌中，肺炎克雷伯菌和鲍曼不动杆菌是医院获得性分离株，其耐药性明显高于社区获得性分离株。阴沟肠杆菌、粘质沙雷菌和铜绿假单胞菌的这种差异不太明显。这些细菌总体上从所有来源获得的耐药性都更强。51%的沙门氏菌对氨苄西林耐药；然而，这些菌株对环丙沙星均敏感。东部地区的分离株耐药性最低。通过绘制抗生素在敏感范围内的抑菌圈直径，我们发现了万古霉素对金黄色葡萄球菌、环丙沙星对大肠杆菌以及环丙沙星对沙门氏菌属的抑菌圈直径较小的亚群。这些发现代表了本次监测的目的之一，因为它们可能预示着未来需要密切关注的耐药性发展情况。
