Laboratoire de Microbiologie, CHU Habib Bourguiba Sfax, Rue El-Ferdaous, 3029 Sfax, Tunisia.
Med Mal Infect. 2012 Jun;42(6):256-63. doi: 10.1016/j.medmal.2012.04.008. Epub 2012 May 23.
The authors had for aim to monitor Enterobacteriaceae resistance to colistin, during 6 years (2005-2010), and to study the epidemiology of Enterobacteriaceae resistant strains isolated in the Sfax region (Tunisia).
This retrospective study was carried out in the microbiology laboratory, at the Habib Bourguiba teaching hospital in Sfax. All strains of colistin resistant Enterobacteriaceae isolated from patients were studied.
One hundred and twenty one strains of colistin resistant Enterobacteriaceae were isolated from 93 patients. Klebsiella pneumoniae was the most frequent species (60.2%), followed by Enterobacter cloacae (26.9%), and Escherichia coli (12.9%). Thirteen strains (E. cloacae) were heteroresistant to colistin. Eighty one isolates (87.1%) were resistant to third generation cephalosporins. The rate of resistance to colistin ranged from 0.09% for E. coli to 1.2% for K. pneumoniae, and 1.5% for E. cloacae. A progressively increasing colistin resistance was observed for K. pneumoniae. Most resistant strains were isolated from urine in the urology department. Previous exposure to colistin was reported in 59.2% of patients. Pulsed field gel electrophoresis typing revealed different clones.
Colistin resistance in Enterobacteriaceae is a worrying phenomenon in Sfax. It is related to polyclonal diffusion. Continuous epidemiological monitoring and a rational use of colistin are necessary to limit the spreading of these colistin resistant strains and to maintain this antibiotic's effectiveness.
作者旨在监测 6 年间（2005-2010 年）肠杆菌科对黏菌素的耐药性，并研究突尼斯斯法克斯地区分离的耐药肠杆菌科菌株的流行病学。
本回顾性研究在斯法克斯的 Habib Bourguiba 教学医院的微生物实验室进行。研究了从患者中分离出的所有黏菌素耐药肠杆菌科菌株。
从 93 名患者中分离出 121 株黏菌素耐药肠杆菌科菌株。肺炎克雷伯菌最为常见（60.2%），其次是阴沟肠杆菌（26.9%）和大肠埃希菌（12.9%）。13 株（阴沟肠杆菌）对黏菌素呈异质耐药。81 株（87.1%）对第三代头孢菌素耐药。黏菌素耐药率范围从大肠埃希菌的 0.09%到肺炎克雷伯菌的 1.2%，阴沟肠杆菌的 1.5%。肺炎克雷伯菌的黏菌素耐药率呈逐渐上升趋势。大多数耐药菌株分离自泌尿科的尿液中。59.2%的患者报告了以前接触过黏菌素。脉冲场凝胶电泳分型显示了不同的克隆。
肠杆菌科对黏菌素的耐药性在斯法克斯是一个令人担忧的现象。它与多克隆扩散有关。需要进行持续的流行病学监测和合理使用黏菌素，以限制这些黏菌素耐药菌株的传播，并保持该抗生素的有效性。
