2004年上海地区细菌耐药性监测

Surveillance of bacterial resistance from hospitals in Shanghai in 2004

目的了解2004年上海地区部分医院临床分离菌株对各类抗菌药物的耐药性。方法采用Kirby-Bauer(KB)法对26890株临床分离株进行药敏试验。结果按NCCLS2004年版标准判断及采用WHONET5.3软件进行统计分析。结果26890株临床分离株中革兰阳性球菌占35.3%(9497/26890),革兰阴性杆菌占64.7%(17393/26890)。MRSA和MRCNS的检出率分别占金葡菌和凝固酶阴性葡萄球菌的63.9%和82.9%。青霉素不敏感肺炎链球菌儿童患者的检出率较成人患者为高,分别为70.1%和8.8%。未发现对万古霉素或替考拉宁耐药的VISA,VRSA或VRE菌株。革兰阴性肠杆菌科细菌中ESBLs的检出率在大肠埃希菌和肺炎克雷伯菌中分别为36.5%和45.0%,24.0%的奇异变形杆菌亦可产生ESBLs。产ES-BLs菌株对大多β内酰胺类抗菌药物高度耐药。亚胺培南和美罗培南对革兰阴性杆菌的抗菌活性最强,两者对肠杆菌科和不动杆菌属的抗菌作用较其他非发酵革兰阴性杆菌好。结论甲氧西林耐药葡萄球菌(MRSA和MRCNS)、儿童中青霉素不敏感肺炎链球菌(PISP和PRSP)以及大肠埃希菌和克雷伯菌属中产ESBLs菌株的检出率高,未发现糖肽类耐药的革兰阳性球菌,抗菌药物对革兰阴性肠杆菌科细菌的抗菌活性较非发酵革兰阴性杆菌好。本组监测资料对细菌性感染的治疗和抗菌药物的选用具有重要参考价值。

Objective To investigate the resistance of clinical isolates from 14 Shanghai hospitals in 2004. Methods Antimicrobial susceptibility testing of 26 890 clinical isolates was carried out by means of Kirby-bauer（KB） and results were analysed according to NCCLS（2004）. Results Of 26 890 clinical isolates, gram negative bacilli and gram positive cocci was accounted for 64.7% and 35. 3% respectively. Methicillin-reslstant Staphylococci （MRSA and MRCNS） were still a major problem the detection rates of MRS being 63.9% in S. aureus , and 82.9 % in coagulase negative Staphylococcus. Penicillin-nonsusceptible S. pneumoniae （P1SP ＋ PRSP） strains accounted for 70.1 % in children isolates, but only 8.8 % in adult isolates. No strains of gram positive cocci were resistant to vancomycin and teicoplanin. No VISA, VRSA or VRE were found. In Enterobacteriaceae, ESBLs-producing strains accounted for 36. 5% and 45. 0% in E. coli and Klebsiella spp. respectively. 24. 0% strains of P. mirabilis also produced ESBLs. ESBLs-producing strains were resistant to most β-lactams and some other antimicrobial agents. Imipenem and meropenem are the most potent antimicroblal agents. The antimicrobial activity of imipenem and meropenem against Enterobacteriaceae strains were better than non-fermantive against gram negative organisms. Conclusions Detection rates of MRSA and MRCNS were high, as well as PISP and PRSP in S. pneumoniae from children isolates and ESBLs in E. coli and Klebsiella spp.. No strains of gram positive cocci resistant to glycopeptides were found. Our data will be useful for the selection of antimicrobial agents for the treatment of bacterial infections.