Antimicrobial activity of 12 broad-spectrum agents tested against 270 nosocomial blood stream infection isolates caused by non-enteric Gram-negative Bacilli: Occurrence of resistance, molecular epidemiology, and screening for metallo-enzymes
Antimicrobial activity of 12 broad-spectrum agents tested against 270 nosocomial blood stream infection isolates caused by non-enteric Gram-negative Bacilli: Occurrence of resistance, molecular epidemiology, and screening for metallo-enzymes
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DOI：
10.1016/s0732-8893(97)81808-1
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发表时间：
1997-11-01
影响因子：
2.9
通讯作者：
Wilke, WW
中科院分区：
文献类型：
--
作者：
Jones, RN;Pfaller, MA;Wilke, WW
共有270个来自美国近50个医疗中心的非肠杆菌科革兰氏阴性杆菌最近的医院血流分离株被鉴定。分离出的细菌有：铜绿假单胞菌204株，不动杆菌属。48例为嗜麦芽窄食单胞菌(n=18)。采用微量肉汤稀释法对12种抗菌药物：哌拉西林、哌拉西林/他唑巴坦、头孢曲松、头孢他啶、头孢吡肟、亚胺培南、环丙沙星、氧氟沙星、阿米卡星、庆大霉素、妥布霉素、三甲氧嘧啶/磺胺甲恶唑进行MIC测定。根据美国国家临床实验室委员会现行标准，对头孢吡肟、头孢他啶和亚胺培南的耐药率分别为：铜绿假单胞菌3、9和5%；不动杆菌2、37和0；嗜麦芽窄食单胞菌88.7、35.3和100%。甲氧苄氨嘧啶/磺胺甲恶唑是对嗜麦芽窄食单胞菌(100%敏感)最有效的药剂。对28株对头孢他啶(MIC)、亚胺培南(MIG)和亚胺培南(MIG)高度耐药的铜绿假单胞菌进行聚合酶链式反应检测，均为阴性。对铜绿假单胞菌分离株的分子分型显示了许多患者特有的菌株，但也注意到由相同DNA类型的分离物引起的感染聚集性，这表明14个医疗中心中的9个可能存在医院传播。鉴于这些非肠道革兰氏阴性杆菌的耐药性和致病潜力，应做出相当大的努力来制定和实施感染控制和抗菌药物使用实践，以限制这些细菌在医院环境中的传播。(C)1997年爱思唯尔科学公司。
A total of 270 recent nosocomial blood stream isolates of non-Enterobacteriaceae Gram-negative bacilli representing nearly 50 U.S. medical centers were characterized. The numbers of isolates of individual organisms were: Pseudomonas aeruginosa (n = 204), Acinetobacter spp. (n = 48), aid Stenotrophomonas maltophilia (n = 18). MICs were determined using the broth microdilution susceptibility method with 12 antimicrobial agents: piperacillin, piperacillin/tazobactam, ceftriaxone, ceftazidime, cefepime, imipenem, ciprofloxacin, ofloxacin, amikacin, gentamicin, tobramycin, and tri methoprim/sulfamethoxazole. Based on current National Committee far Clinical Laboratory Standards breakpoints, rates of resistance to cefepime, ceftazidime, and imipenem were as follows : P. aeruginosa, 3, 9, and 5%; Acinetobacter spp., 2, 37, and 0%; and S. maltophilia, 88.7, 35.3, and 100%, respectively. Trimethoprim/sulfamethoxazole was the most active agent against S. maltophilia (100% susceptible). Twenty-eight isolates of P. aeruginosa that expressed high levels of resistance to ceftazidime (MIC, >256 mu g/mL) and imipenem (MIG, >32 mu g/mL) were examined for potential metallo-beta-lactamase production by polymerase chain reaction and were found to be negative. Molecular typing of P. aeruginosa isolates revealed many patient-unique strains, but also noted clustering of infections due to isolates of the same DNA type, suggesting possible nosocomial transmission in 9 of 14 medical centers. Given the resistance profile and pathogenic potential of these non-enteric Gram-negative bacilli, considerable effort should be exerted to develop and enforce infection control and antimicrobial utilization practices that will limit the spread of these organisms in the hospital environment. (C) 1997 Elsevier Science Inc.