Wang Qi, Zhao Chun-jiang, Wang Hui, Yu Yun-song, Zhu Zhen-hong, Chu Yun-zhuo, Sun Zi-yong, Hu Zhi-dong, Xu Xiu-li, Liao Kang, Xu Ying-chun, Zhang Li-yan, Mei Ya-ning, Yang Bin, Ni Yu-xing
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2013 May 14;93(18):1388-96.
To explore the antimicrobial resistance of nosocomial Gram-negative bacilli across China.
A total of 1247 consecutive and non-repetitive Gram-negative bacilli were isolated from 13 Chinese teaching hospitals from March to August 2012. All isolates were sent to a central laboratory for reidentification and susceptibility testing. The minimal inhibitory concentration (MICs) of meropenem and other antibacterial agents were determined by agar dilution method. And the data were analyzed with WHONET-5.6 software.
The activity of antimicrobial agents against Enterobacteriaceae was in the following descending order of susceptibility rate: meropenem (97.5%, 849/871) , amikacin (94.5%, 823/871) , imipenem (93.6%, 815/871) , ertapenem (92.9%, 809/871) , piperacillin/tazobactam (89.9%, 783/871) , cefoperazone/sulbactam (83.5%, 727/871) , cefepime (78.1%, 680/871) , polymyxin B (77.0%, 670/871) , cefiazidime (69.6%, 606/871) , levofloxacin (69.2%, 603/871) , ciprofloxacin (63.6%, 554/871) , minocyline (63.1%, 550/871) , ceftriaxone (55.7%, 485/871) , cefotaxime (54.2%, 472/871) and cefoxitin (51.4%, 448/871) . The prevalence of extended-spectrum beta-lactamase (ESBL) was 64.3% (117/182) in Escherichia coli (E. coli) and 32.1% (60/187) in Klebsiella pneumonia (K. pneumoniae) . The sensitivities of E. coli to meropenem and imipenem were 100%. And over 90% of E. coli was sensitive to ertapenem, amikacin, piperacillin/tazobactam and polymyxin B. However, over 60% of E. coli was resistant to ciprofloxacin, levofloxacin, ceftriaxone and cefotaxime. The susceptibility of K. pneumoniae to meropenem, imipenem, amikacin and polymyxin B maintained at over 90%. The activities of antimicrobial agents against E. cloacae, E. aerogenes and Citrobacter freundii were in the following descending order of susceptibility rate: meropenem (96.0%-100%) , imipenem (96.0%-100%) , polymyxin B (95.8%-100%) , amikacin (92.2%-100%) , ertapenem (85.6%-93.3%) , cefepime (77.8%-93.3%) , cefoperazone/sulbactam (78.4%-90.0%) and piperacillin/tazobactam (65.0%-89.8%) . The most susceptible agent against Acinetobacter baumannii (A. baumannii) was polymyxin B (100%) . The susceptibilities of A.baumannii to imipenem, meropenem and minocyline were 37.8% (65/172) , 36.0% (62/172) and 62.8% (108/172) respectively. The most active agents against Pseudomonas aeruginosa (P. aeruginosa) were polymyxin B (97.2%, 173/178) , followed by amikacin (89.3%, 159/178) and cefiazidime (83.7%, 149/178) . Clinical and Laboratory Standards Institute revised P.aeruginosa susceptibility standard in 2012. The sensitivity of piperacillin/tazobactam changed from 83.7% (149/178) to 77.5% (138/178) . The sensitivity of meropenem decreased from 78.1% ( 139/178 ) to 71.3% ( 127/178 ) while that of imipenem declined from 69.7% (124/178) to 59.6% (106/178) . The prevalence of multi-drug resistant A. baumannii and P. aeruginosa were 65.7% (113/172) and 9.0% (16/178) respectively.
Carbapenems remain highly active against Enterobacteriaceae. Increasing resistance of A. baumannii to all antimicrobial agents is noted. New breakpoint to P.aeruginosa has obvious effects on antimicrobial sensitivity.
探讨中国医院革兰阴性杆菌的耐药情况。
2012年3月至8月，从13家中国教学医院连续分离出1247株非重复革兰阴性杆菌。所有分离菌株均送至中心实验室进行重新鉴定和药敏试验。采用琼脂稀释法测定美罗培南及其他抗菌药物的最低抑菌浓度（MIC）。数据用WHONET-5.6软件进行分析。
抗菌药物对肠杆菌科细菌的活性按敏感率由高到低依次为：美罗培南（97.5%，849/871）、阿米卡星（94.5%，823/871）、亚胺培南（93.6%，815/871）、厄他培南（92.9%，809/871）、哌拉西林/他唑巴坦（89.9%，783/871）、头孢哌酮/舒巴坦（83.5%，727/871）、头孢吡肟（78.1%，680/871）、多黏菌素B（77.0%，670/871）、头孢他啶（69.6%，606/871）、左氧氟沙星（69.2%，603/871）、环丙沙星（63.6%，554/871）、米诺环素（63.1%，550/871）、头孢曲松（55.7%，485/871）、头孢噻肟（54.2%，472/871）和头孢西丁（51.4%，448/871）。大肠埃希菌中产超广谱β-内酰胺酶（ESBL）的比例为64.3%（117/182），肺炎克雷伯菌中为32.1%（60/187）。大肠埃希菌对美罗培南和亚胺培南的敏感性为100%。超过90%的大肠埃希菌对厄他培南、阿米卡星、哌拉西林/他唑巴坦和多黏菌素B敏感。然而，超过60%的大肠埃希菌对环丙沙星、左氧氟沙星、头孢曲松和头孢噻肟耐药。肺炎克雷伯菌对美罗培南、亚胺培南、阿米卡星和多黏菌素B的敏感性维持在90%以上。抗菌药物对阴沟肠杆菌、产气肠杆菌和弗劳地枸橼酸杆菌的活性按敏感率由高到低依次为：美罗培南（96.0% - 100%）、亚胺培南（96.0% - 100%）、多黏菌素B（95.8% - 100%）、阿米卡星（92.2% - 100%）、厄他培南（85.6% - 93.3%）、头孢吡肟（77.8% - 93.3%）、头孢哌酮/舒巴坦（78.4% - 90.0%）和哌拉西林/他唑巴坦（65.0% - 89.8%）。鲍曼不动杆菌对多黏菌素B的敏感性最高（100%）。鲍曼不动杆菌对亚胺培南、美罗培南和米诺环素的敏感性分别为37.8%（65/172）、36.0%（62/172）和62.8%（108/172）。对铜绿假单胞菌活性最强的药物是多黏菌素B（97.2%，173/178），其次是阿米卡星（89.3%，159/178）和头孢他啶（83.7%，149/178）。临床和实验室标准协会于2012年修订了铜绿假单胞菌药敏标准。哌拉西林/他唑巴坦的敏感性从83.7%（149/178）变为77.5%（138/178）。美罗培南的敏感性从78.1%（139/178）降至71.3%（127/178），亚胺培南的敏感性从69.7%（124/178）降至59.6%（106/178）。多重耐药鲍曼不动杆菌和铜绿假单胞菌的比例分别为65.7%（113/172）和9.0%（16/178）。
碳青霉烯类药物对肠杆菌科细菌仍保持高活性。鲍曼不动杆菌对所有抗菌药物的耐药性不断增加。铜绿假单胞菌新的药敏折点对抗菌药物敏感性有明显影响。
