目的 探讨不同年份CLSI文件中头孢吡肟折点变化对肠杆菌科细菌药敏结果的影响,辅助临床合理调整用药。方法 应用2013年(S23)与2014年(S24)CLSI文件中的头孢吡肟折点回顾性分析我院2014年肠杆菌科细菌的药敏变化情况。结果 与S23折点相比,肠杆菌科细菌中大肠埃希菌、肺炎克雷伯菌对头孢吡肟的耐药率分别上升了2.6%、2.8%,耐药率差异有统计学意义(P<0.05);产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌以及非产ESBLs肺炎克雷伯菌对头孢吡肟的耐药率分别上升了3.8%、2.4%、2.0%,耐药率差异有统计学意义(P<0.05); 对于其它肠杆菌科细菌如非产ESBLs大肠埃希菌、阴沟肠杆菌等对头孢吡肟的耐药率变化无差异(P>0.05)。与S23相比,在S24中头孢吡肟MIC值分布在4 μg/mL、8 μg/mL、16 μg/mL时对细菌的药敏变化最为显著。结论 依照S24折点,肠杆菌科细菌对头孢吡肟的耐药率有不同程度的升高;尤其对产ESBLs菌株耐药率影响更大;临床应结合实验室报告合理调整用药。

Objective To investigate the change of the break point of the CLSI in different years on the drug sensitivity of Enterobacteriaceae bacteria. This is valuable for rational use of antibiotics. Methods To retrospective analyze 2014 Enterobacteriaceae bacteria susceptibility variation by CLSI file cefepime breakpoint of 2013(S23) and 2014(S24). Results Compared with breakpoint of S23, E. coli and Klebsiella pneumonia, cefepime resistant rate rose by 2.6% and 2.8% respectively, and the resistance difference was statistically significant (P<0.05); ESBLs-producing E. coli, ESBLs-producing Klebsiella pneumoniae and ESBLs non-producing Klebsiella pneumoniae toword cefepime resistant rate rose by 3.8%, 2.4% and 2.0% respectively, and the resistance difference was statistically significant (P<0.05); For other Enterobacteriaceae bacteria, such as ESBLs non-producing E. coli and Enterobacter cloacae with cefepime in drug resistance rate had no significant difference (P>0.05). Compared with S23, variety in drug susceptibility of bacteria was most significant in S24, during cefepime MIC of 4 μg/mL, 8 μg/mL, 16 μg/mL. Conclusion According to the S24 breakpoint, the drug resistance rates of the bacteria in the intestines of the bacteria is increasing, especially in ESBLs strain; antibiotics use should be following laboratory results.