2008年北京协和医院细菌耐药性监测结果分析

CHINET Surveillance of antibiotic resistance in clinical isolates from Peking Union Medical College Hospital during 2008

目的监测我院2008年临床分离株的耐药谱。方法收集我院患者首次非重复分离株5264株。纸片扩散法测定分离株对抗菌药物的敏感性,用WHONET5.4软件进行耐药性分析。结果肠杆菌属、柠檬酸杆菌属对碳青霉烯类的耐药率<4%,其他肠杆菌科细菌未发现对碳青霉烯类抗生素耐药菌株。常见肠杆菌科细菌对哌拉西林-他唑巴坦、头孢哌酮-舒巴坦的耐药率低<16%,头孢吡肟除ESBL阳性大肠埃希菌、克雷伯菌属、奇异变形杆菌的耐药率>30%外,其他菌属耐药率均<20%。头孢他啶、头孢噻肟、头孢曲松、头孢哌酮除沙雷菌属和奇异变形杆菌外,其他菌属的耐药率均>30%。大肠埃希菌、克雷伯菌属ESBL阳性率分别为52.5%、37.2%。铜绿假单胞菌对美罗培南、亚胺培南的耐药率分别为20.3%、27.7%,对碳青霉烯类抗生素耐药铜绿假单胞菌(CRPA)占10.4%(56/541)。鲍曼不动杆菌对米诺环素、头孢哌酮-舒巴坦的耐药率分别为22.5%、35.2%,对其余测试药物耐药率均>60%,碳青霉烯类抗生素耐药的鲍曼不动杆菌(CRAB)占44.2%(248/561)。葡萄球菌属、肠球菌属及链球菌属均对利奈唑胺、万古霉素、替考拉宁敏感。MRSA和MRCNS的检出率分别为57.2%和77.0%,万古霉素耐药的肠球菌占4.7%,青霉素耐药的肺炎链球菌(PRSP)占22.9%,未发现青霉素和氨苄西林耐药的β溶血性链球菌。结论碳青霉烯类抗生素对革兰阴性杆菌,利奈唑胺、万古霉素对革兰阳性球菌仍为抗菌活性最强的抗菌药物,但是耐药菌株及多重耐药株菌VRE、CRAB、CRPA已经出现并有上升趋势。

Objective To investigate the antimicrobial resistance of clinical isolates during 2008.Methods A total of 5 264 non-duplicate isolates were collected.The susceptibility was tested by disk diffusion method.All the data were analyzed by WHONET 5.4 software.Results The prevalence of carbapenems-resistant Enterobacter spp.and Citrobacter spp.isolates was lower than 4%.Carbapenem-resistant isolate was not found in other common Enterobacteriaceae species.As for the isolates of common Enterobacteriaceae species,less than 16% were resistant to piperacillin-tazobactam or cefoperazone-sulbactam.More than 30% of ESBLs-positive E.coli,Klebsiella spp.and Proteus mirabilis isolates were resistant to cefepime.The prevalence of cefepime-resistant isolates was lower than 20% in other bacterial species.The resistance rate of other bacterial species except Serratia spp.and Proteus mirabilis was higher than 30% to ceftazidime,cefepime,ceftriaxone and cefoperazone.The prevalence of ESBLs-positive E.coli and Klebsiella spp.was 52.5% and 37.2% respectively.The percentage of P.aeruginosa isolates resistant to meropenem,imipenem was 20.3% and 27.7%,respectively.The prevalence of carbapenems-resistant P.aeruginosa (CRPA) was 10.4% (56/541).The percentage of A.baumannii isolates resistant to minocycline,cefoperazone-sulbactam was 22.5% and 35.2%.The percentage was higher than 60% to the other antibiotics.The prevalence of carbapenems-resistant A.baumannii (CRAB) was 44.2% (248/561).Staphylococcus spp.,Enterococcus spp.and S.pneumoniae were all susceptible to linezolid,vancomycin and teicoplanin.About 57.2% of S.aureus (MRSA) and 77.0% of coagulase-negative Staphylococcus isolates (MRCNS) were methicillin-resistant.Resistance to vancomycin was found in 4.7% of Enterococcus spp.isolates.About 22.9% of the S.pneumoniae isolates were resistant to penicillin (PRSP).None of beta-hemolytic Streptococcus isolates was resistant to penicillin or ampicillin.Conclusions Carbapenems are still the most active antibacterial agents for gram-negative bacilli;while for gram-positive cocci,the most active antibacterial agents are linezolid and vancomycin.However,it seems that antibiotic-resistant strains and multidrug-resistant MRSA,VRE,CRAB,CRPA are growing in this hospital.