湖北地区临床分离菌耐药性监测

A surveillance study on antimicrobial resistance of clinical isolates from the tertiary hospitals in Hubei area

目的 :了解湖北地区三级医院临床分离菌的耐药状况 ,分析 1996 - 2 0 0 2年细菌谱和耐药谱的变迁。方法 :收集 2 0 0 2年 1月至 12月湖北地区 15所三级医院临床分离菌 ,用Kirby Bauer方法药敏试验的抑菌圈直径输入计算机 ,采用“WHONET5”软件进行统计分析 ,根据美国国家临床实验室标准委员会 (NCCLS) 2 0 0 2年标准判定耐药性。结果 :2 0 0 2年共分离临床细菌 12 4 92株 ,革兰阳性球菌占 39.4 % ,革兰阴性杆菌占 6 0 .6 %。甲氧西林耐药金黄色葡萄球菌 (MRSA)和甲氧西林耐药凝固酶阴性葡萄球菌 (MRCNS)分别占金黄色葡萄球菌 (SA)和凝固酶阴性葡萄球菌 (CNS)的 38.6 %和 72 .6 %。 2 0 0 2年大肠埃希菌产超广谱 β内酰胺酶 (ESBLs)株占31.3% ,克雷伯菌属产ESBLs株占 34.7%。结论 :湖北地区大肠埃希菌、克雷伯菌属、肠杆菌属、铜绿假单胞菌和不动杆菌属对常用抗菌药物的耐药率逐年增加。对革兰阴性杆菌作用较强的亚胺培南、头孢他啶、头孢噻肟、哌拉西林、阿米卡星、庆大霉素和环丙沙星的敏感率逐年下降。细菌耐药性呈逐年上升趋势 ,需要多方面共同努力 ,建立控制耐药性增长多元体系。

Objective: To investigate the antimicrobial resistance of clinical isolates from tertiary hospitals in Hubei area. Methods:Data of bacterial susceptibility testing of clinical isolates from 15 tertiary hospitals in Hubei area from January 1 to December 31, 2002 were collected and analyzed by software WHONET 5. Results were assessed according to NCCLS 2002. Results:Out of 12 492 isolates, 39.4% strains were gram-positive cocci, while 60.6% being gram-negative bacilli. MRSA and MRCNS were detected in 38.6% and 72.6% strains of S. aureus and coagulase-negative staphylococci, respectively. ESBLs producing strains were detected in 31.3% of E. coli and 34.7% of Klebsiella spp. strains. Conclusions:Resistance rates of E. coli, Klebsiella spp, Enterobacter spp, P. aeruginosa and Acinetobacter spp. to commonly used antimicrobials are increasing. The susceptibility rates of gram-negative organisms to imipenem, ceftazidime, cefotaxime, piperacillin, amikacin, gentamicin and ciprofloxacin are decreasing. Antimicrobial resistance rates of clinical isolates in Hubei area are increasing. Effective measures for the control of antimicrobial resistance are urgently needed.