CAJ | 학술논문

目的：监测2012年我国主要城市三级医院临床分离非发酵革兰阴性杆菌对常用抗菌药物的敏感性。方法收集2012年557家三级医院临床分离非发酵革兰阴性杆菌，按照2012年美国实验室标准化研究所制定的操作标准，用微量稀释法、纸片扩散法或E－test法进行细菌药物敏感性测定，用WHONET 5.6软件分析实验结果。结果共收集临床分离革兰阴性菌598295株，非发酵革兰阴性菌198334株（占33.1％），其中铜绿假单胞菌80964株（占非发酵革兰阴性菌40.8％）、鲍曼不动杆菌67368株（占34.0％）、嗜麦芽窄食单胞菌17520株（占8.8％）。铜绿假单胞菌对多黏菌素B、妥布霉素、头孢他啶、环丙沙星、左氧氟沙星、头孢吡肟、庆大霉素及头孢哌酮／舒巴坦的敏感性均高于70％。对于鲍曼不动杆菌，除多黏菌素B（敏感率96.9％）、米诺环素（敏感率61.4％）、阿米卡星（敏感率58.7％）、头孢哌酮／舒巴坦（敏感率54.3％）与妥布霉素（敏感率51.3％）外，其他被测药物的敏感率均低于50％，对碳青霉烯类的敏感率约为49.0％，较2011年检测结果升高约9个百分点。全国不同地区的耐药监测结果存在一定差异，华中地区铜绿假单胞菌与鲍曼不动杆菌对被测药物的敏感率普遍偏低，华北地区鲍曼不动杆菌对被测药物的敏感率普遍偏高。结论非发酵革兰阴性杆菌尤其是鲍曼不动杆菌的多重耐药已引起世界关注，全国不同地区对药物的敏感性存在一定差异。对铜绿假单胞菌与鲍曼不动杆菌，多黏菌素B的体外抗菌活性最强，但其敏感率有下降趋势，且已出现耐药菌株，应加强监测，以减缓耐药菌株的发展与传播。
목적：감측2012년아국주요성시삼급의원림상분리비발효혁란음성간균대상용항균약물적민감성。방법수집2012년557가삼급의원림상분리비발효혁란음성간균，안조2012년미국실험실표준화연구소제정적조작표준，용미량희석법、지편확산법혹E－test법진행세균약물민감성측정，용WHONET 5.6연건분석실험결과。결과공수집림상분리혁란음성균598295주，비발효혁란음성균198334주（점33.1％），기중동록가단포균80964주（점비발효혁란음성균40.8％）、포만불동간균67368주（점34.0％）、기맥아착식단포균17520주（점8.8％）。동록가단포균대다점균소B、타포매소、두포타정、배병사성、좌양불사성、두포필우、경대매소급두포고동／서파탄적민감성균고우70％。대우포만불동간균，제다점균소B（민감솔96.9％）、미낙배소（민감솔61.4％）、아미잡성（민감솔58.7％）、두포고동／서파탄（민감솔54.3％）여타포매소（민감솔51.3％）외，기타피측약물적민감솔균저우50％，대탄청매희류적민감솔약위49.0％，교2011년검측결과승고약9개백분점。전국불동지구적내약감측결과존재일정차이，화중지구동록가단포균여포만불동간균대피측약물적민감솔보편편저，화북지구포만불동간균대피측약물적민감솔보편편고。결론비발효혁란음성간균우기시포만불동간균적다중내약이인기세계관주，전국불동지구대약물적민감성존재일정차이。대동록가단포균여포만불동간균，다점균소B적체외항균활성최강，단기민감솔유하강추세，차이출현내약균주，응가강감측，이감완내약균주적발전여전파。
Objective To investigate the antimicrobial resistance of nonfermenting gram-negative bacteria in China in 2012.Methods All the clinical isolates of nonfermenting gram -negative bacteria were collected from 557 tertiary hospitals from 1st January 2012 to 31st December 2012 in China.The antimicrobial susceptibilities of the isolates were de-termined by using various methods such as broth microdilution, disk diffusion, or E-test which according to CLSI 2012 guideline.The sus-ceptibility data were processed with WHONET 5.6 software.Results A total of 198334 nonfermenting gram-negative bacteria susceptibility data were obtained.Among all the isolates, the top 3 isolated nonfermenting gram-negative strains were Pseudomonas aeruginosa ( 80964 strains, 40.8%) , followed by Acinetobacter baumannii(67368 strains, 34.0%) , and Stenotrophomonas maltophilia ( 17520 strains, 8.8%).Against Pseudomonas aeruginosa, polymyxin B, tobramycin, ceftazidime, ciprofloxacin, levofloxacin, cefepime, gentamicin and cefoperazone/sulbactam ( CSL) were the only agents to which >70%of isolates were susceptible.No antibiotics except polymyxin B ( 96.9%) , minocycline ( 61.4%) , amikacin (58.7%), CSL (54.3%) and tobramycin (51.3%) were active more than 50% against Acinetobacter baumannii.Susceptibility rates of carbapenem against Acinetobacter baumannii were around 49%, about 9 percentage points higher than 2011 results.There are some differences among the monitoring results from various districts in China.The suscep-tibilities of Pseudomonas aeruginosa and Acinetobacter baumannii to the tested antimicrobial agents in Central China were generally low, whereas the antimicrobial susceptibilities of Acinetobacter baumannii from North China were genera-lly high.Conclusion The multidrug resistance of nonfermenting gram -negative bacteria, especially Acinetobacter baumannii, has become a worldwide problem.There are some differences among the susceptibilities of isolates from various districts.Polymyxin B has the most effective in vitro antimicrobial activity against Pseudomonas aeruginosa and Acinetobacter baumannii isolates, the emerging resistant isolates should cause enough attention.Further surveillance needed to be strengthened to prevent the further development and spread of resistant bacteria.