Pitt T L, Sparrow M, Warner M, Stefanidou M
Laboratory of HealthCare Associated Infection, Specialist and Reference Microbiology Division, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT, UK.
Thorax. 2003 Sep;58(9):794-6. doi: 10.1136/thorax.58.9.794.
Respiratory infection with Pseudomonas aeruginosa is very common in patients with cystic fibrosis (CF) but antimicrobial resistance rates of CF isolates across the UK are largely unknown.
The susceptibility of 417 CF patient isolates of P aeruginosa from 17 hospitals to six commonly prescribed antibiotics were examined. Isolates were tested by an agar break point dilution method and E-tests according to British Society of Antimicrobial Chemotherapy guidelines. Genotyping of isolates was performed by XbaI DNA macrorestriction and pulsed field gel electrophoresis.
38% of isolates were susceptible to all of the agents tested; almost half were resistant to gentamicin compared with ceftazidime (39%), piperacillin (32%), ciprofloxacin (30%), tobramycin (10%), and colistin (3%). Approximately 40% were resistant to two or more compounds with ceftazidime in combination with gentamicin, piperacillin or ciprofloxacin being the most common cross resistances. Resistance rates were generally similar to those reported recently from the USA and Germany. A selection of resistant isolates proved to be predominantly genotypically distinct by XbaI DNA macrorestriction but six pairs from three centres had similar genotypes.
The level of resistance to front line antipseudomonal agents, with the exception of colistin, is disturbingly high. The prudent use of antimicrobial drugs and closer monitoring of accumulation of resistant strain populations should be actively considered.
铜绿假单胞菌呼吸道感染在囊性纤维化（CF）患者中非常常见，但英国CF分离株的抗菌药物耐药率基本未知。
检测了来自17家医院的417株CF患者的铜绿假单胞菌分离株对六种常用抗生素的敏感性。根据英国抗菌化疗协会指南，采用琼脂断点稀释法和E试验对分离株进行检测。通过XbaI DNA宏观限制性内切酶消化和脉冲场凝胶电泳对分离株进行基因分型。
38%的分离株对所有测试药物敏感；与头孢他啶（39%）、哌拉西林（32%）、环丙沙星（30%）、妥布霉素（10%）和黏菌素（3%）相比，近一半的分离株对庆大霉素耐药。约40%的分离株对两种或更多种化合物耐药，头孢他啶与庆大霉素、哌拉西林或环丙沙星联合耐药最为常见。耐药率总体上与美国和德国最近报道的相似。通过XbaI DNA宏观限制性内切酶消化，一组耐药分离株在基因型上主要不同，但来自三个中心的六对分离株具有相似的基因型。
除黏菌素外，一线抗假单胞菌药物的耐药水平高得令人不安。应积极考虑谨慎使用抗菌药物并密切监测耐药菌株群体的积累。
