【摘要】 目的 了解临床常见革兰阴性杆菌对替加环素的耐药情况。方法 收集2012年9月~10月浙江省9个城市15家医院的393株鲍曼不动杆菌复合群以及2012年1月~12月浙江大学医学院附属第二医院的115株大肠埃希菌,110株肺炎克雷伯菌和99株鲍曼不动杆菌复合群。用Vitek-2 Compact全自动微生物鉴定仪对细菌做鉴定及药物敏感性试验。393株分离自全省的鲍曼不动杆菌复合群用基质辅助激光解析/电离飞行时间质谱仪(matrix-assistedlaserdesorption/ionization time of flight mass spectrometr,MALDI-TOF MS)进行鉴定。另外挑取393株鲍曼不动杆菌复合群中GNAST16药敏卡MIC值≥8μg/ml或4μg/ml的所有菌株以及少部分MIC值在≤0.5μg/ml~2μg/ml之间的不动杆菌159株,这些菌株同时采用Etest法和GN-AST16药敏卡对替加环素的药敏情况进行比较。结果 393株鲍曼不动杆菌复合群经MALDI-TOF MS鉴定为317株鲍曼不动杆菌,32株皮氏不动杆菌和44株医院不动杆菌。采用FDA标准,115株大肠埃希菌对替加环素的耐药率为0.0%;110株肺炎克雷伯菌对替加环素的耐药率为7.3%;99株鲍曼不动杆菌复合群对替加环素的耐药率为6.1%。替加环素耐药革兰阴性杆菌中,85.7%(12/14)对碳青霉烯类耐药;而碳青霉烯类耐药革兰阴性杆菌中,仅10.0%(12/120)对替加环素耐药。结论 替加环素对临床常见的多重耐药甚至泛耐药革兰阴性杆菌有较好的抗菌活性。不管采用FDA还是EUCAST判读标准,Etest方法的耐药率比GN-AST16药敏卡方法稍低。更多还原

【Abstract】 Objective To investigate the resistance of clinical isolated gram negative bacilli to tigecycline.Methods One hundred and fifteen Escherichia coli isolates,110 Klebsiella pneumoniae isolates and 99 Acinetobacter calcoaceticus-Acinetobacter baumannii complex isolates were collected from Affiliated Second Hospital of Zhejiang University College of Medicine from the year 2012.The other 393 A.calcoaceticus-A.baumannii complex isolates were collected from 15 hospitals of nine cities in Zhejiang province during September to October 2012.Species identification and susceptibility test were confirmed by VITEK-2 compact system,while the 393 A.calcoaceticus-A.baumannii complex strains isolated from Zhejiang province were identified by MALDI-TOF MS.Moreover,159 A.baumannii isolates with tigecycline MIC value ≥8 μg/ml or 4 μg/ml and part of the MIC value ≤0.5 fig/ml,1 jug/ml and 2 μg/ml which were firstly determined by VITEK 2 GN AST-16 Susceptibility card were then determined by Etest.Results The 393 A.calcoaceticus-A.baumannii complex strains were identified as317 of A.baumannii,32 of A.pittii and 44 of A.nosocomialis.When using the FDA breakpoints,the resistance rate of tigecycline against 115 E.coli isolates,110 K.pneumoniae isolates and 99 A.calcoaceticus-A.baumannii complex isolates were0.0%,7.3%and 6.1%.respectively.Interestingly,85.7%of the tigecycline-resistant gram negative bacilli were resistant to carbapenems.However,only 10.0%of the carbapenem-resistant gram negative bacilli were resistant to tigecycline.Conclusion Tigecycline had a good activity against clinical isolated multi-drug resistant or even pan-drug resistant gram negative bacilli.No matter which criteria for tigecycline was referred to,the resistance rate of tigecycline was slightly lower by Etest than by GN AST-16 Susceptibility card.更多还原