Mamishi Setareh, Pourakbari Babak, Ashtiani Mohammad H, Hashemi Farhad B
Department of Pediatric Infectious Disease, Children's Medical Center Hospital, School of Medicine, Tehran University of Medical Sciences, 100 Gharib St., Keshavarz Blvd, Tehran, Iran.
Int J Antimicrob Agents. 2005 Nov;26(5):373-9. doi: 10.1016/j.ijantimicag.2005.08.004. Epub 2005 Oct 4.
Antimicrobial susceptibility patterns of major bloodstream pathogens from Iran provide essential information regarding the selection of antibiotic therapy for patients with bloodstream infections (BSIs) living in Iran. Unfortunately, data regarding the isolation frequency and antimicrobial susceptibility patterns of endemic BSI pathogens are scarce in Iran. To shed some light on the susceptibility patterns of BSI pathogens endemic to Tehran, Iran, we investigated the antimicrobial susceptibility patterns of 2248 bloodstream isolates from patients in Children's Medical Center (CMC) Hospital in Tehran between January 1996 and December 2000. Microbiology reports of 24600 blood specimens collected from inpatients in CMC Hospital were retrospectively reviewed. Specimen culture, bacterial identification and disk diffusion susceptibility testing were performed according to National Committee for Clinical Laboratory Standards guidelines. Overall, Gram-positive bacteria comprised 72% (1627/2248) of recovered isolates and Gram-negative bacteria comprised 28% (621/2248). Coagulase-negative staphylococci (CoNS) comprised 48.4% of all isolates, followed by Staphylococcus aureus (16.7%) and Klebsiella spp. (8.5%). Among the 621 Gram-negative organisms, Klebsiella spp. (31%) were the most frequently isolated, followed by Escherichia coli (21%) and Pseudomonas aeruginosa (17%). The rates of oxacillin resistance for S. aureus and CoNS isolates were similar (60% versus 61%); however, the rate of S. aureus vancomycin resistance was almost twice that of CoNS resistance (21% versus 11%). Over 55% of S. pneumoniae were resistant to penicillin and co-trimoxazole. Although all isolates of enterococci were susceptible to vancomycin, only 21% were susceptible to gentamicin. Among Gram-negative isolates, amikacin was shown to be very effective, with susceptibility rates of 84%. The susceptibility of Klebsiella spp. to ampicillin and co-trimoxazole was 1% and 39%, respectively. The susceptibility of Klebsiella spp., E. coli and Enterobacter spp. to ceftriaxone was 47%, 86% and 67%, respectively. There were notable differences in the order of the five most common organisms isolated from blood cultures, which can help set priorities for focused control efforts. Our findings highlight the importance of a nationwide surveillance programme to monitor the trends in isolation frequency of bacteria and their antimicrobial resistance patterns throughout Iran.
来自伊朗的主要血流病原体的抗菌药敏模式，为居住在伊朗的血流感染（BSI）患者的抗生素治疗选择提供了重要信息。遗憾的是，伊朗关于地方性BSI病原体的分离频率和抗菌药敏模式的数据匮乏。为了阐明伊朗德黑兰地方性BSI病原体的药敏模式，我们调查了1996年1月至2000年12月期间德黑兰儿童医学中心（CMC）医院患者的2248株血流分离株的抗菌药敏模式。我们回顾性审查了从CMC医院住院患者采集的24600份血标本的微生物学报告。根据美国国家临床实验室标准委员会的指南进行标本培养、细菌鉴定和纸片扩散药敏试验。总体而言，革兰氏阳性菌占分离株的72%（1627/2248），革兰氏阴性菌占28%（621/2248）。凝固酶阴性葡萄球菌（CoNS）占所有分离株的48.4%，其次是金黄色葡萄球菌（16.7%）和克雷伯菌属（8.5%）。在621株革兰氏阴性菌中，克雷伯菌属（31%）是最常分离到的，其次是大肠杆菌（21%）和铜绿假单胞菌（17%）。金黄色葡萄球菌和CoNS分离株对苯唑西林的耐药率相似（60%对61%）；然而，金黄色葡萄球菌对万古霉素的耐药率几乎是CoNS耐药率的两倍（21%对11%）。超过55%的肺炎链球菌对青霉素和复方新诺明耐药。虽然所有肠球菌分离株对万古霉素敏感，但只有21%对庆大霉素敏感。在革兰氏阴性分离株中，阿米卡星显示出非常有效，药敏率为84%。克雷伯菌属对氨苄西林和复方新诺明的药敏率分别为1%和39%。克雷伯菌属、大肠杆菌和肠杆菌属对头孢曲松的药敏率分别为47%、86%和67%。从血培养中分离出的五种最常见病原体的顺序存在显著差异，这有助于为重点控制工作确定优先事项。我们的研究结果强调了全国性监测计划对于监测全伊朗细菌分离频率趋势及其抗菌耐药模式的重要性。
