Mohnarin 2008年度报告:外科细菌耐药监测分析

2008 Mohnarin report:Bacterial resistance in surgery of China

目的总结全国89家教学医院2008年度临床外科系统分离病原菌的耐药状况。方法常规方法培养分离医院内感染病原菌，并应用半自动或全自动细菌鉴定分析仪鉴定到种，药敏试验方法按CLSI规定的标准进行。采用WHONET5．4软件进行数据统计分析。结果全国89家教学医院外科系统共分离出病原菌株15736株，其中革兰阴性菌10357株占分离菌的65．83％，革兰阳性菌5326株占分离菌的33．85％。大肠埃希菌超广谱β-内酰胺酶（ESBLs）的产酶率为43．47％（1184／2724），肺炎克雷伯菌产酶率为31．73％（469／1478）。在大肠埃希菌和肺炎克雷伯菌中均发现对亚胺培南和美罗培南耐药的菌株。大肠埃希菌和肺炎克雷伯菌对哌拉西林／三唑巴坦和头孢哌酮／舒巴坦的耐药率分别为5．9％～11．3％及8．4％～30．5％，而铜绿假单胞菌和鲍曼不动杆菌对哌拉西林／三唑巴坦和头孢哌酮／舒巴坦的耐药率分别为17．6％～27-3％及18．0％～66．3％。革兰阳性球菌中，耐甲氧西林的金黄色葡萄球菌（MRSA）的发生率为67．48％（1023／1516），耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的发生率为57．20％（659／1152）。未发现耐万古霉素的葡萄球菌。粪肠球菌对替考拉宁和万古霉素耐药率分别为1．6％和1．4％，屎肠球菌对替考拉宁和万古霉素耐药率分别为3．6％和3．5％。结论大肠埃希菌、金黄色葡萄球菌和铜绿假单胞菌仍是院内感染的重要痫原菌。阿米卡星、哌拉西林／三唑巴坦、头孢哌酮／舒巴坦及碳氢酶烯类药物对肠杆菌科细菌的抗菌活性仍处于比较高的水平，但在主要的肠杆菌科细菌中都已出现对碳氢酶烯类药物耐药的菌株。头孢哌酮／舒巴坦对非发酵菌具有较好的抗菌活性。耐甲氧西林葡萄球菌和耐万古霉素的肠球菌仍是抗菌药物治疗中的重点和难点。因此，微生物工作者应加强对产酶菌和多重耐药菌的监测，为临床正确合理使用抗菌药物提供依据。

Objective Summarizing the drug resistance of pathogens surgery in 2008 from 89 hospitals in China. Methods Isolates were cultured by routine method and identified by the semi-automatic or automatic bacteria analysis system. Drug susceptibility test was according to CLSI standards. WHONET5.4 software was used to Data statistic and analyze. Results A total of 157,361 clinical isolates were collected from 89 hospitals, of which Gram negative bacteria and Gram positive bacteria accounted for 65.83% and 33.85%（1,184/2,724）. The positive rate of extending spectrum ~3-1actamases of E.coli was 43.47%（1,184/2,724）, ESBLs-Klebsiella spp. was 31.73%（469/1,478）. There were some E. coli and Klebsiella spp strains were resistant to imipenem and meropenem. The drug resistant rate of E. coli and Klebsiella spp. against piperacillin/tazobactam and cefopcrazone/sulbactam were 5.9%-11/3% and 8.4%-30.5%. P aeruginosa and A.baumannii were 17.6%-27.3% and 18.0%-66.3%. MRSA were 67.08%, MRCNS were 57.20%. All isolates of Staphylococcus were susceptible to vancomycin. The drug resistant rates of Enterococcus faecalis against teicoplanin and vancomycin were 0.7% and 1.4%, Enterococcusfaecium were 3.2% and 3.5%. Conclusion E. coli, S.aureus and P. aeruginosa were the most important antimicrobial in hospital infection. Enterobacteriaceae against amikacin, piperacillin/tazobactam, cefopcrazone/sulbactam and carbapenems has good antibacterial activity. There were some strains resistant to impenem and meropenem were found in mainly Enterobacteriaceae. Strains of non-fermentative gram-negative bacilli were still highly susceptible to cefopcrazone/ sulbactarn. MRSA and vancomycin resistant Entarococcus faecium are difficult problem to resolve. We should enhance supervision of drug resistance bacteria produced enzyme and multi-resistant bacteria, in order to guide rational administration in clinic