Jarlier V, Fosse T, Philippon A
Laboratoire de Bactériologie, Hôpital Pitié-Salpêtrière, Paris, France.
Intensive Care Med. 1996 Oct;22(10):1057-65. doi: 10.1007/BF01699228.
Evaluation of the distribution and antibiotic susceptibility of the aerobic gram-negative bacilli (AGNB) isolated from patients in intensive care units (ICU study).
Microbiological study carried out in 1991 in 39 teaching hospitals. A standardized method was used to determine the minimum inhibitory concentrations of 12 antibiotics against 3366 strains of AGNB (close to 100 strains per hospital) during a period of 3 months.
The 2773 initial strains (i.e., the first AGNB isolate for a given species and a given patient) were mainly isolated from the respiratory tract (34.4%), urinary tract (23%), or blood (9.6%) and were mainly Pseudomonas aeruginosa (22.9%), Escherichia coli (22%), Acinetobacter (9.7%), and Klebsiella pneumoniae (8.3%). E. coli was prominent in urine and blood and P. aeruginosa in the respiratory tract. Overall, the rate of susceptibility of AGNB was 58 to 65% to piperacillin, cefotaxime, and gentamicin; 69 to 75% to aztreonam, tobramycin, and ciprofloxacin; 83% to ceftazidime; and 91% to imipenem. The overall rates of susceptibility were higher for the initial strains isolated from blood than for those from the urinary or respiratory tracts, mostly reflecting differences in species distribution. Susceptibility rates were lower for the 593 repeat strains (i.e., all the subsequent isolates for a given species and a given patient) than for the initial strains, mostly due to the higher proportion of resistant species (P. aeruginosa 45.9%) but also due to the difference in susceptibility rates for some species-antibiotic combinations. Concomitant resistance (i.e., resistance to several antibiotics due to independent mechanisms of resistance) was marked between beta-lactams and aminoglycosides or quinolones, particularly in P. aeruginosa and K. pneumoniae.
Rates of resistance in AGNB as a whole and in particular species (P. aeruginosa, Klebsiella), as well as frequency of concomitant resistance found in the French ICU study, were higher than those found in ICU studies conducted with the same methodology in Belgium, The Netherlands, and Germany, which may reflect differences in case mix.
评估从重症监护病房患者中分离出的需氧革兰氏阴性杆菌（AGNB）的分布及抗生素敏感性（ICU研究）。
1991年在39家教学医院开展的微生物学研究。采用标准化方法，在3个月期间测定12种抗生素对3366株AGNB（每家医院近100株）的最低抑菌浓度。
2773株初始菌株（即给定物种和给定患者的首个AGNB分离株）主要从呼吸道（34.4%）、泌尿道（23%）或血液（9.6%）分离得到，主要为铜绿假单胞菌（22.9%）、大肠埃希菌（22%）、不动杆菌（9.7%）和肺炎克雷伯菌（8.3%）。大肠埃希菌在尿液和血液中占主导，铜绿假单胞菌在呼吸道中占主导。总体而言，AGNB对哌拉西林、头孢噻肟和庆大霉素的敏感率为58%至65%；对氨曲南、妥布霉素和环丙沙星的敏感率为69%至75%；对头孢他啶的敏感率为83%；对亚胺培南的敏感率为91%。从血液中分离出的初始菌株的总体敏感率高于从泌尿道或呼吸道分离出的菌株，这主要反映了物种分布的差异。593株重复菌株（即给定物种和给定患者的所有后续分离株）比初始菌株的敏感率低，这主要是由于耐药物种比例较高（铜绿假单胞菌占45.9%），但也归因于某些物种 - 抗生素组合的敏感率差异。β - 内酰胺类与氨基糖苷类或喹诺酮类之间存在显著的同时耐药（即由于独立耐药机制对多种抗生素耐药），特别是在铜绿假单胞菌和肺炎克雷伯菌中。
在法国ICU研究中，AGNB总体及特定物种（铜绿假单胞菌、克雷伯菌）的耐药率以及同时耐药的频率高于在比利时、荷兰和德国采用相同方法进行的ICU研究，这可能反映了病例组合的差异。
