耐万古霉素肠球菌以及对头孢西丁、亚胺培南和氟喹诺酮耐药的革兰氏阴性杆菌的患病率不断上升：2002年的一项KONSAR研究。

Increasing prevalence of vancomycin-resistant enterococci, and cefoxitin-, imipenem- and fluoroquinolone-resistant gram-negative bacilli: a KONSAR study in 2002.

作者信息

Lee Kyungwon, Kim Young Ah, Park Yeon Joon, Lee Hye Soo, Kim Moon Yeun, Kim Eui Chong, Yong Dongeun, Chong Yunsop

机构信息

Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.

出版信息

Yonsei Med J. 2004 Aug 31;45(4):598-608. doi: 10.3349/ymj.2004.45.4.598.

DOI:10.3349/ymj.2004.45.4.598

PMID:15344199

Abstract

Continued antimicrobial resistance surveillance can provide valuable information for the empirical selection of antimicrobial agents for patient treatment, and for resistance control. In this 6th annual study for 2002, the susceptibility data at 39 Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR) hospitals were analyzed. Resistance rates of S. aureus were 67% to oxacillin, and 58% to clindamycin. The ampicillin and vancomycin resistance rates of E. faecium were 89% and 16%, respectively. To penicillin, 71% of S. pneumoniae were nonsusceptible. Resistance rates of E. coli were 11% to cefotaxime, 8% to cefoxitin, and 34% to fluoroquinolone, and those of K. pneumoniae were 22% to ceftazidime, and 16% to cefoxitin. Lowest resistance rates to cephalosporins shown by E. cloacae and S. marcescens were to cefepime, 7% and 17%, respectively. This is the first KONSAR surveillance, which detected imipenem-resistant E. coli and K. pneumoniae. To imipenem, 22% of P. aeruginosa and 9% of Acinetobacter spp. were resistant. Trends of resistances showed a slight reduction in MRSA and in penicillin- nonsusceptible S. pneumoniae, but an increase in ampicillin-resistant E. faecium. Ampicillin-resistant E. coli and H. influenzae remained prevalent. Compared to the previous study, amikacin- and fluoroquinolone- resistant Acinetobacter spp. increased to 60% and 62%, respectively. Ceftazidime- resistant K. pneumoniae decreased slightly, and imipenem- resistant P. aeruginosa and Acinetobacter spp., and vancomycin-resistant E. faecium increased. In conclusion, vancomycin-resistant E. faecium, cefoxitin-resistant E. coli and K. pneumoniae, and imipenem-resistant P. aeruginosa and Acinetobacter spp. increased gradually, and imipenem- resistant E. coli and K. pneumoniae appeared for the first time. Continued surveillance is required to prevent further spread of these serious resistances.

摘要

持续的抗菌药物耐药性监测可为患者治疗中抗菌药物的经验性选择以及耐药性控制提供有价值的信息。在这项针对2002年的第六届年度研究中，分析了韩国全国抗菌药物耐药性监测（KONSAR）的39家医院的药敏数据。金黄色葡萄球菌对苯唑西林的耐药率为67%，对克林霉素的耐药率为58%。粪肠球菌对氨苄西林和万古霉素的耐药率分别为89%和16%。肺炎链球菌对青霉素不敏感的比例为71%。大肠埃希菌对头孢噻肟的耐药率为11%，对头孢西丁的耐药率为8%，对氟喹诺酮类的耐药率为34%；肺炎克雷伯菌对头孢他啶的耐药率为22%，对头孢西丁的耐药率为16%。阴沟肠杆菌和粘质沙雷氏菌对头孢菌素类耐药率最低的是头孢吡肟，分别为7%和17%。这是KONSAR首次监测到对亚胺培南耐药的大肠埃希菌和肺炎克雷伯菌。铜绿假单胞菌对亚胺培南的耐药率为22%，不动杆菌属对亚胺培南的耐药率为9%。耐药趋势显示，耐甲氧西林金黄色葡萄球菌和对青霉素不敏感的肺炎链球菌略有下降，但耐氨苄西林粪肠球菌有所增加。耐氨苄西林大肠埃希菌和流感嗜血杆菌仍然普遍存在。与之前的研究相比，耐阿米卡星和耐氟喹诺酮的不动杆菌属分别增至60%和62%。耐头孢他啶的肺炎克雷伯菌略有下降，耐亚胺培南的铜绿假单胞菌和不动杆菌属以及耐万古霉素的粪肠球菌有所增加。总之，耐万古霉素粪肠球菌、耐头孢西丁大肠埃希菌和肺炎克雷伯菌以及耐亚胺培南铜绿假单胞菌和不动杆菌属逐渐增加，并且首次出现了耐亚胺培南的大肠埃希菌和肺炎克雷伯菌。需要持续监测以防止这些严重耐药性的进一步传播。