Antimicrobial Susceptibility of Multi-drug Resistant Acinetobacter Baumannii and Pseudomonas Aeruginosa Isolates from 27 Hospitals in China
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摘要:
目的 研究医院感染相关多重耐药鲍曼不动杆菌(multi-drug resistant Acinetobacter baumannii, MDR-AB)及多重耐药铜绿假单胞菌(multi-drug resistant Pseudomonas aeruginosa, MDR-PA)对12种抗菌药物的敏感性。 方法 收集2011年8月至2012年7月全国27所教学医院分离的医院感染相关MDR-AB及MDR-PA菌株。所有菌株均分离自有明确感染意义的临床标本, 严格排除痰及筛查性拭子。菌株收集后统一在微生物实验室采用微量肉汤稀释法, 测定其对12种抗菌药物的最小抑菌浓度(minimum inhibitory concentration, MIC), 并同时用CLSI M100-S24及M100-S23/S21鲍曼不动杆菌和铜绿假单胞菌的碳青霉烯类新旧折点进行对比分析。 结果 本研究共收集到MDR-AB 664株, 未发现全耐药鲍曼不动杆菌; 收集到MDR-PA 268株, 其中有4株全耐药铜绿假单胞菌。外科病房及ICU病房是多重耐药菌株的主要来源。MDR-AB对黏菌素的敏感率最高, 为96.8%;替加环素的敏感率为72.6%, 其余药物的敏感率均低于55%。MDR-PA对黏菌素的敏感率仅为72.4%, 但对阿米卡星的敏感率(64.2%)明显高于MDR-AB(16.7%)。在CLSI折点改变后, MDR-AB对亚胺培南及美罗培南的敏感率仅分别下降了1.3%和0.6%, 但MDR-PA对亚胺培南及美罗培南的敏感率分别下降了5.5%和8.6%。ICU病房来源的MDR-AB及MDR-PA对碳青霉烯酶类药物敏感率都明显低于外科及其他病房。不同地域来源多重耐药菌株的耐药谱有所差异。 结论 黏菌素和替加环素对MDR-AB有良好的抗菌活性, 黏菌素及阿米卡星对MDR-PA抗菌活性较好。 Abstract:Objective To investigate the antimicrobial susceptibilities of nosocomial multi-drug resistantAcinetobacter baumannii(MDR-AB) and multi-drug resistant Pseudomonas aeruginosa(MDR-PA) isolates. Methods MDR-AB and MDR-PA isolates were collected between August 2011 and July 2012 from 27 hospitals in China. All isolates were collected from high quality samples with definite infection diagnoses, whilst isolates from sputum and screen samples were strictly excluded. Minimum inhibitory concentrations (MICs) of 12 commonly used antimicrobial agents were tested by broth microdilution method in a microbiology laboratory. CLSI clinical breakpoints(CBPs) of pre- and post-revision were applied and compared in determination of MDR. Results A total of 664 MDR-AB and 268 MDR-PA isolates were collected. Pan-drug resistant (PDR) was detected in four Pseudomonas aeruginosa but not in Acinetobacter baumannii. The majority of isolates were collected from ICUs and surgical wards. Colistin and tigecycline were the most active agents against MDR-AB (96.8% and 72.6% susceptible, respectively), while no other drug exhibited activity of > 55% susceptible. Only 72.4% of MDR-PA isolates remained susceptible to colistin, but amikacin was more active to MDR-PA (64.2%) than MDR-AB (16.7%). By applying revised CBPs, the susceptibility of MDR-AB isolates to imipenem and meropenem decreased by 1.3% and 0.6%, respectively, whereas the susceptibility of MDR-PA to these two drugs decreased by 5.5% and 8.6%, respectively. The carbapenems susceptible rate of isolates collected from ICUs was lower than surgical and other wards. Isolates collected from different geographic regions showed varied resistant profiles. Conclusions Colistin and tigecycline are the most active drugs against MDR-AB, while colistin and amikacin have comparably good performance to MDR-PA. -
表 1 多重耐药鲍曼不动杆菌及铜绿假单胞菌体外药敏结果
抗菌药物 MDR-AB MDR-PA 敏感率
(%)MIC50
(μg/ml)MIC90
(μg/ml)敏感率
(%)MIC50
(μg/ml)MIC90
(μg/ml)头孢哌酮/
舒巴坦N/A 32 >32 N/A >32 >32 哌拉西林/
他唑巴坦8.6 >128 >128 7.1 128 >128 头孢他啶 3.5 64 >64 19.8 32 >64 头孢吡肟 2.3 >32 >32 6.3 >32 >32 氨曲南 1.5 >16 >16 10.1 >16 >16 亚胺培南 12.0 >8 >8 14.6 >8 >8 美罗培南 12.2 >8 >8 16.4 >8 >8 阿米卡星 16.7 >128 >128 64.2 8 >128 环丙沙星 1.5 >16 >16 19.0 16 >16 黏菌素 96.8 1 2 72.4 2 4 米诺环素 52.6 4 >16 N/A >16 >16 替加环素* 72.6* 2 4 N/A 8 >8 N/A:无法判定;MDR-AB:多重耐药鲍曼不动杆菌;MDR-PA:多重耐药铜绿假单胞菌;MIC:最小抑菌浓度
*按照美国FDA推荐折点判定表 2 亚胺培南及美罗培南MIC分布及新旧折点菌株敏感率比较(%)
抗菌药物 敏感率 MIC(μg/ml)分布(累积百分率) M100-S24 M100-S23/21 0.064 0.125 0.25 0.5 1 2 4 8 >8 多重耐药鲍曼不动杆菌 亚胺培南 12.0 13.3 0 0.2 1.6 3.3 8.9 12.2 13.4 14.3 100 美罗培南 12.2 12.8 1.2 1.2 2.3 5.6 9.8 12.2 12.8 14.2 100 多重耐药鲍曼不动杆菌 亚胺培南 14.6 20.1 0 0 0.4 0.4 4.1 14.5 20.1 27.9 100 美罗培南 16.4 25.0 0.4 0.8 1.5 4.9 9.4 16.5 25.1 38.9 100 MIC:同表 1 表 3 不同科室多重耐药鲍曼不动杆菌及铜绿假单胞菌体外药物敏感率比较(%)
抗菌药物 多重耐药鲍曼不动杆菌 多重耐药铜绿假单胞菌 ICU 外科 其他 ICU 外科 其他 菌株数(n) 264 265 135 73 104 91 哌拉西林/
他唑巴坦4.9 10.6* 11.9* 8.2 4.8 8.8 头孢他啶 3.8 3 3.7 17.8 20.2 20.9 头孢吡肟 0.8 3 3.7 4.1 6.7 7.7 氨曲南 1.1 1.9 1.5 12.3 5.8 13.2 亚胺培南 4.2 18.9* 14.1* 6.8 11.5* 24.2* 美罗培南 4.2 19.2* 14.1* 6.8 13.5* 27.5* 阿米卡星 15.5 14 24.4* 61.6 61.5 69.2 环丙沙星 1.1 1.5 2.2 15.1 17.3 24.2 黏菌素 96.2 97.7 96.3 74 77.9 64.8 米诺环素 48.5 55.1 55.6 N/A N/A N/A 替加环素 71.6 72.5 74.8 N/A N/A N/A N/A:无法判定; 与ICU病房比较,*P<0.05;与外科病房比较,P<0.05 表 4 全国各地区多重耐药鲍曼不动杆菌及铜绿假单胞菌药物敏感率比较(%)
抗菌药物 东北
地区华北
地区华东
地区西北
地区西南
地区中南
地区多重耐药鲍曼不动杆菌 菌株数 94 56 143 97 62 212 哌拉西林/
他唑巴坦8.5 8.9 2.1 16.5 8.1 9.4 头孢他啶 2.1 1.8 7.7 2.1 0 3.3 头孢吡肟 3.2 0 0.7 2.1 1.6 3.8 氨曲南 1.1 0 1.4 2.1 1.6 1.9 亚胺培南 11.7 12.5 5.6 19.6 9.7 13.7 美罗培南 9.6 12.5 6.3 21.6 9.7 13.7 阿米卡星 11.7 21.4 18.2 15.5 29 13.7 环丙沙星 2.1 5.4 0 1 1.6 1.4 黏菌素 100 92.9 93 96.9 100 98.1 米诺环素 68.1 42.9 27.3 62.9 98.4 47.2 替加环素 87.2 76.8 63.6 73.2 100 62.7 多重耐药铜绿假单胞菌 菌株数 28 48 47 15 54 76 哌拉西林/
他唑巴坦0 6.2 14.9 6.7 5.6 6.6 头孢他啶 21.4 10.4 14.9 6.7 42.6 14.5 头孢吡肟 7.1 0 6.4 6.7 1.9 13.2 氨曲南 0 4.2 8.5 0 11.1 19.7 亚胺培南 14.3 22.9 4.3 6.7 1.9 26.3 美罗培南 17.9 27.1 10.6 13.3 7.4 19.7 阿米卡星 60.7 41.9 55.3 86.7 98.1 52.6 环丙沙星 28.6 31.2 17 26.7 0 21.1 黏菌素 60.7 66.7 57.4 60 92.6 77.6 华北地区:北京市、天津市、河北省、山西省、内蒙古自治区;东北地区:辽宁省、吉林省、黑龙江省;华东地区:浙江省、安徽省、山东省;中南地区:河南省、湖北省、湖南省、广东省、海南省、广西壮族自治区;西南地区:四川省、云南省;西北地区:陕西省、甘肃省、青海省、宁夏回族自治区、新疆维吾尔自治区 -
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