Itokazu G S, Quinn J P, Bell-Dixon C, Kahan F M, Weinstein R A
Cook County Hospital, Chicago, Illinois, USA.
Clin Infect Dis. 1996 Oct;23(4):779-84. doi: 10.1093/clinids/23.4.779.
We assessed the rates of antimicrobial resistance between 1990 and 1993 in intensive care units in the United States. A standardized microtiter minimal inhibitory concentration panel was used to test approximately 100 consecutive gram-negative aerobic isolates that were recovered primarily from blood, wounds, urine, and pulmonary sites in patients treated in each of 396 intensive care units in 45 states. Amikacin and imipenem were the agents most active against the 33,869 nonduplicate isolates (those recovered only once) tested. Resistance of aerobic gram-negative bacilli to third-generation cephalosporins was found to be an emerging problem. Increases in rates of resistance to ceftazidime among isolates of Klebsiella pneumoniae (from 3.6% to 14.4%; P << .01) and Enterobacter species (from 30.8% to 38.3%; P = .0004) were noted from 1990 to 1993; rates of resistance among Pseudomonas aeruginosa isolates remained stable. Ceftazidime-resistant bacteria were frequently resistant to aminoglycosides and ciprofloxacin. Risk factors for ceftazidime resistance included the number of beds in the hospital, the teaching status of the hospital, and specific body sites from which the isolates were recovered.
我们评估了1990年至1993年间美国重症监护病房的抗菌药物耐药率。采用标准化微量滴定板最低抑菌浓度检测法，对来自45个州396个重症监护病房接受治疗患者的血液、伤口、尿液及肺部等部位的约100株连续分离的需氧革兰阴性菌进行检测。阿米卡星和亚胺培南是对所检测的33,869株非重复分离菌（仅分离到一次的菌株）活性最强的药物。需氧革兰阴性杆菌对第三代头孢菌素的耐药性已成为一个新出现的问题。1990年至1993年间，肺炎克雷伯菌分离株对头孢他啶的耐药率从3.6%增至14.4%（P << 0.01），肠杆菌属分离株对头孢他啶的耐药率从30.8%增至38.3%（P = 0.0004）；铜绿假单胞菌分离株的耐药率保持稳定。对头孢他啶耐药的细菌常常对氨基糖苷类和环丙沙星耐药。头孢他啶耐药的危险因素包括医院的床位数、医院的教学性质以及分离菌株的具体身体部位。
