Mohnarin 2010年度报告:华东地区细菌耐药监测

Mohnarin report 2010:Surveillance of bacterial resistance in east China

目的了解2010年华东地区临床分离菌的分布和耐药特征,指导临床合理使用抗菌药物。方法采用纸片扩散法(K-B法)或自动化仪器法对2010年华东地区15所医院临床分离菌株进行药敏试验,按CLSI 2010年标准判定药敏结果,并用WHONET5.5软件进行数据分析。结果 15所医院共分离细菌42 659株,其中革兰阴性菌29 202株,占68.4%,革兰阳性菌13 385株,占31.4%,厌氧菌72株,占0.2%;大肠埃希菌和金黄色葡萄球菌分别占据革兰阴性杆菌和革兰阳性球菌的首位;产超广谱β-内酰胺酶(ESBLs)大肠埃希菌、肺炎克雷伯菌和奇异变形菌的检出率分别为68.7%、49.0%和31.4%;葡萄球菌属中MRSA和MRSCN的检出率分别为49.9%和74.1%;肠杆菌科细菌对碳青霉烯类抗菌药物高度敏感,敏感率91.8%～99.5%,除沙雷菌属和奇异变形菌外,对其他β-内酰类抗菌药物的敏感率均<80.0%;铜绿假单胞菌除阿米卡星外对各抗菌药物的敏感率均<75.0%,而不动杆菌属除对阿米卡星、米诺环素外,对其他各种抗菌药物敏感率均<50.0%;肠球菌属对万古霉素和替考拉宁有0.7%～4.6%的耐药率。结论华东地区细菌耐药性严重,除产ESBLs的大肠埃希菌和肺炎克雷伯菌、MRSA等,应密切关注耐碳青霉烯类肠杆菌科细菌。

OBJECTIVE To investigate the distribution characteristics and drug resistance profile of clinical isolates in east China in 2010. METHODS The susceptibility testing of clinical isolates in 15 hospitals from east China was performed by using K-B method or automated system.The results were analyzed by WHONET 5.5 according to CLSI 2010 breakpoints. RESULTS Of 42 659 clinical isolates,68.4% was Gram-negative bacilli and 31.4% was Gram-positive cocci.Escherichia coli was the most frequently isolated pathogen in Gram-negative bacilli.Staphylococcus aureus was the most common pathogen in Gram-positive cocci.49.9% of S.aureus was MRSA and 74.1% of coagulase-negative Staphylococci were methicillin-resistant.ESBLs were detected in 68.7% of E.coli,49.0% of Klebsiella pneumonia and 31.4% of Proteus mirabilis strains respectively.Enterobacteriaceae were highly sensitive to carbapenem,with the sensitivity rates reaching 91.8%-99.5%,and the sensitivity to β-lactamase antibiotics of Enterobacteriaceae,except serratia and proteus mirabilis,were 80.0%;PAE was with the sensitivity less than 75.0% to antibiotics except amikacin;Acinetobacter spp were with the sensitivity less than 50.0% to antibiotics except amikacin and minocycline;the resistance rates of Enterococcus to vancomycin and teicoplanin were 0.7%-4.6%. CONCLUSION Antimicrobial resistance of clinical bacterial isolates is still increasing in east China,it should pay close attention to carbapenem-resistant Enterobacteriaceae,besides ESBLs-producing E.coli,K.pneumoniae and MRSA.