2012年江苏地区12家医院细菌耐药监测评价

Monitoring and assessment on antimicrobial resistance of bacteria in 12 hospitals of Jiangsu province,China,2012

目的监测评价2012年江苏地区12家医院细菌耐药情况。方法收集48 683株非重复细菌信息,用仪器法或K-B纸片扩散法进行药敏试验,结果按美国临床和实验室标准化协会(CLSI)2011年版标准判读,用WHONET 5.6软件进行统计分析。结果 8 786株葡萄球菌中,对苯唑西林耐药者占63.8%。2 744株肠球菌中粪肠球菌对各类抗菌药物较屎肠球菌敏感,但对万古霉素中介的粪肠球菌比率达7.1%。155株肺炎链球菌中,按非脑膜炎的折点判读,对青霉素的敏感率超过80%;按脑膜炎的折点判读,对青霉素的敏感率明显降低。20 245株肠杆菌科细菌中对碳青霉烯类药物的敏感率最高,其中亚胺培南敏感率为93.2%,敏感率超过70%的有阿米卡星(82.5%)和哌拉西林/他唑巴坦(76.3%)。非发酵菌中5 658株鲍曼不动杆菌对亚胺培南和美罗培南的耐药率高达67.9%和72.5%,对所测的其他11种药物的耐药率均超过60%。6 393株铜绿假单胞菌对抗菌药物的耐药率明显低于鲍曼不动杆菌。156株流感嗜血杆菌对阿奇霉素的敏感性为100%,敏感率在75%以上的有哌拉西林/他唑巴坦、头孢噻肟和左氧氟沙星。结论耐甲氧西林葡萄球菌仍是革兰阳性菌中所占比例最高的细菌。屎肠球菌分离率的升高预示着临床治疗肠球菌引起的感染将更加棘手。碳青霉烯类药物对肠杆菌科细菌虽保持较高的活性,但是敏感率已经有所下降。非发酵菌中,鲍曼不动杆菌对碳青霉烯类的耐药率升高最快。铜绿假单胞菌对碳青霉烯类的耐药率已超过对第三代和第四代头孢菌素的耐药率。

Objective To monitor and assess the antimicrobial resistant of bacteria in 12 hospitals of Jiangsu province during the year of 2012. Methods A total of 48 683 non-repetitive messages on bacteria were collected. The drug susceptibilities were tested by auto- mated microbiology system or Kirby-Bauer disk dilution method. The results were interpreted by the Criteria published by the Clinical and Laboratory Standards Institute （ CLSI 2011 ）. The data were statistically analyzed by WHONET 5.6 software. Result Among the 8 786 strains of Staphylococcus methieillin-resistant rate were 63.8%. Among the isolated 2 744 strains of Enteroeoccus, the drug sus- eeptibilies of E. faecalis to all the antibiotics were higher than those of E. faecium, but the intermediate susceptibility rate for vancomycin were 7.1% in E.faecalis. Among the 155 strains of Streptococcus pneumoniae the susceptibility rate of penicillin was more than 80% according to the break point of non-meningitis,, but the susceptibility rate of penicillin reduced obviously according to meningitis. In the 20 245 strains of Enterobacteriaceae, the highest susceptibility rate was shown in carbapenems in which imipenems exhibited susceptibility rate of 93.2% , and the other 2 antibiotics with susceptibility rates of over 70% were amikacin（ 82.5% ） and piperacillin/tazobactam （76.3 % ）. In non-ferment bacterium, 5 658 strains of Acinetobacter baumannii showed drug-resistant rate of 67.9% to imipenems, 72.5% to meropenem, and more than 60% to other 11 examined antibiotics. The drug-resistant rate of 6 393 strains of Pseudomons aeruginosa was obviously lower than that of Acinetobacter baumannii. The strains of H. influenzae isolated from 156 patiems showed the susceptibility rate of 100% to azithromycin and over 75% to piperacillin/tazobactam, cefotaxime and levofloxacin. Conclusion The detectable rate of methicillin-resistant Staphylococcus still was the highest of gram-positive cocci. The rise of isolation rate of E.faecium may predict more difficult treatment for infection caused by enterococcus. Carbapenems kept very high antibacterial activity against Enterobacteriaceae, but the susceptibility rate was reducing. In non-ferment bacterium, the resistance of Acinetobacter baumannii to carbapenems increased at the fastest rate. The resistance rate of Pseudomons aeruginosa to carbapenems exceeded that of the thirdor fourth-generation cephalosporin.