Karlowsky James A, Jones Mark E, Thornsberry Clyde, Friedland Ian R, Sahm Daniel F
Focus Technologies, Herndon, Virginia 20171, USA.
Antimicrob Agents Chemother. 2003 May;47(5):1672-80. doi: 10.1128/AAC.47.5.1672-1680.2003.
Longitudinal surveillance of Enterobacteriaceae for antimicrobial susceptibility is important because species of this family are among the most significant and prevalent human pathogens. To estimate rates of in vitro antimicrobial susceptibility among hospitalized patients in the United States, data from The Surveillance Network were studied for 14 agents tested against 10 species of Enterobacteriaceae (n = 384,279) isolated from intensive-care-unit (ICU) patients and non-ICU inpatients from 1998 to 2001. Cumulative susceptibility (percent) data for all species of Enterobacteriaceae isolated from ICU patients and non-ICU inpatients, respectively, were ranked as follows: ampicillin-sulbactam (45.5 and 57.2) << ticarcillin-clavulanate (74.8 and 83.5) < trimethoprim-sulfamethoxazole (87.0 and 84.5) congruent with cefotaxime (82.9 and 92.6) = ceftazidime (82.3 and 91.0) = ceftriaxone (86.5 and 93.9) = piperacillin-tazobactam (83.5 and 90.5) < levofloxacin (89.3 and 90.6) = ciprofloxacin (91.0 and 91.7) < gentamicin (91.8 and 94.3) < cefepime (95.0 and 97.9) < amikacin (98.5 and 99.2) < imipenem (100 and 100) = meropenem (100 and 100). Of those agents studied only susceptibilities to ciprofloxacin (94 to 89%) and levofloxacin (93 to 89%) decreased in a stepwise manner from 1998 to 2001. Decreased fluoroquinolone susceptibility was most pronounced for Escherichia coli, Proteus mirabilis, and Enterobacter cloacae. For all species of Enterobacteriaceae, trimethoprim-sulfamethoxazole resistance was more commonly observed in isolates with a single-drug resistance phenotype while gentamicin and fluoroquinolone resistances were more common in isolates resistant to at least one additional class of antimicrobial agent. Ongoing surveillance of Enterobacteriaceae will be particularly important to monitor changes in fluoroquinolone susceptibility, as well as changes in the prevalence of isolates resistant to multiple classes of antimicrobial agents.
对肠杆菌科细菌进行抗菌药物敏感性的纵向监测很重要，因为该菌科的菌种是最重要且最常见的人类病原体之一。为了估算美国住院患者的体外抗菌药物敏感性发生率，研究了监测网络1998年至2001年期间针对从重症监护病房（ICU）患者和非ICU住院患者分离出的10种肠杆菌科细菌（n = 384,279）检测的14种药物的数据。分别从ICU患者和非ICU住院患者中分离出的所有肠杆菌科菌种的累积敏感性（百分比）数据排名如下：氨苄西林-舒巴坦（45.5和57.2）<<替卡西林-克拉维酸（74.8和83.5）<甲氧苄啶-磺胺甲恶唑（87.0和84.5）≈头孢噻肟（82.9和92.6）=头孢他啶（82.3和91.0）=头孢曲松（86.5和93.9）=哌拉西林-他唑巴坦（83.5和90.5）<左氧氟沙星（89.3和90.6）=环丙沙星（91.0和91.7）<庆大霉素（91.8和94.3）<头孢吡肟（95.0和97.9）<阿米卡星（98.5和99.2）<亚胺培南（100和100）=美罗培南（100和100）。在研究的这些药物中，只有环丙沙星（94%至89%）和左氧氟沙星（93%至89%）的敏感性在1998年至2001年期间呈逐步下降趋势。氟喹诺酮敏感性降低在大肠杆菌、奇异变形杆菌和阴沟肠杆菌中最为明显。对于所有肠杆菌科菌种，甲氧苄啶-磺胺甲恶唑耐药性在单一耐药表型的分离株中更常见，而庆大霉素和氟喹诺酮耐药性在对至少一类其他抗菌药物耐药的分离株中更常见。持续监测肠杆菌科细菌对于监测氟喹诺酮敏感性的变化以及对多类抗菌药物耐药的分离株流行率的变化尤为重要。
