台湾嗜麦芽寡养单胞菌的抗微生物药物耐药性多中心监测。
A multicenter surveillance of antimicrobial resistance on Stenotrophomonas maltophilia in Taiwan.
机构信息
Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
出版信息
J Microbiol Immunol Infect. 2012 Apr;45(2):120-6. doi: 10.1016/j.jmii.2011.09.028. Epub 2011 Dec 11.
BACKGROUND
Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in debilitated hosts. Clinical management of S. maltophilia is challenging due to its intrinsic resistance to a variety of antibiotics. This study investigated the trend and prevalence of antimicrobial resistance in S. maltophilia from a nationwide surveillance study in Taiwan.
METHODS
S. maltophilia isolates were collected biennially between 1998 and 2008 as part of the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program from medical centers and regional hospitals throughout Taiwan. Minimal inhibitory concentrations (MIC) were determined using the Clinical and Laboratory Standards Institute reference broth microdilution method.
RESULTS
A total of 377 non-duplicate S. maltophilia isolates were collected from 38 hospitals. The majority of the isolates were from the respiratory tract (256, 67.9%), followed by blood (48, 12.7%). Overall, 376 (99.7%) isolates were susceptible to minocycline, 362 (96%) to tigecycline, 311 (82.5%) to trimethoprim/sulfamethoxazole (TMP-SMX), 300 (79.6%) to levofloxacin, 92 (24.4%) to ceftazidime, and 70 (18.6%) to ticarcillin-clavulanic acid. The MIC(50)/MIC(90) of minocycline, tigecycline, TMP-SMX, levofloxacin, ceftazidime, and ticarcillin-clavulanic acid, were ≤0.5/1 μg/mL, 0.25/1 μg/mL, ≤0.25/8 μg/mL, 1/4 μg/mL, 32/128 μg/mL, and 64/128 μg/mL, respectively. A trend of increased non-susceptibility to levofloxacin (p=0.014) was observed over the 10-year study period. Compared to TMP-SMX-susceptible isolates, TMP-SMX-resistant isolates were less susceptible to levofloxacin (54.5% vs. 84.9%, p<0.001).
CONCLUSION
In this 10-year study, minocycline and TMP-SMX remained the two antimicrobials with better in vitro activities against S. maltophilia than ceftazidime, levofloxacin, and ticarcillin-clavulanic acid. The activity of levofloxacin against S. maltophilia in Taiwan declined during the past 10 years.
背景
嗜麦芽窄食单胞菌已成为衰弱宿主中一种重要的机会致病菌。由于其对多种抗生素固有耐药，临床管理嗜麦芽窄食单胞菌具有挑战性。本研究通过台湾全国性监测研究调查了嗜麦芽窄食单胞菌的抗生素耐药趋势和流行率。
方法
1998 年至 2008 年期间，嗜麦芽窄食单胞菌分离株作为台湾监测抗生素耐药性（TSAR）计划的一部分，每两年从台湾各地的医疗中心和区域医院采集一次。使用临床和实验室标准协会参考肉汤微量稀释法测定最小抑菌浓度（MIC）。
结果
从 38 家医院共采集了 377 株非重复嗜麦芽窄食单胞菌。大多数分离株来自呼吸道（256 株，占 67.9%），其次是血液（48 株，占 12.7%）。总体而言，376 株（99.7%）分离株对米诺环素敏感，362 株（96%）对替加环素敏感，311 株（82.5%）对复方磺胺甲噁唑（TMP-SMX）敏感，300 株（79.6%）对左氧氟沙星敏感，92 株（24.4%）对头孢他啶敏感，70 株（18.6%）对替卡西林-克拉维酸敏感。米诺环素、替加环素、TMP-SMX、左氧氟沙星、头孢他啶和替卡西林-克拉维酸的 MIC（50）/MIC（90）分别为≤0.5/1μg/mL、0.25/1μg/mL、≤0.25/8μg/mL、1/4μg/mL、32/128μg/mL 和 64/128μg/mL。在 10 年的研究期间，观察到左氧氟沙星的非敏感性呈上升趋势（p=0.014）。与 TMP-SMX 敏感分离株相比，TMP-SMX 耐药分离株对左氧氟沙星的敏感性较低（54.5%对 84.9%，p<0.001）。
结论
在这项为期 10 年的研究中，米诺环素和 TMP-SMX 对嗜麦芽窄食单胞菌的体外活性仍优于头孢他啶、左氧氟沙星和替卡西林-克拉维酸。在过去的 10 年中，台湾地区嗜麦芽窄食单胞菌对左氧氟沙星的活性下降。
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