2005中国CHINET细菌耐药性监测结果

CHINET 2005 surveillance of bacterial resistance in China

目的了解国内主要地区医院临床分离菌对各类抗菌药物的耐药性。方法联合国内8所较有代表性的综合性医院,按统一方案、采用统一的材料、方法(Kirby-Bauer法)和判断标准(CLSI／NCCLS 2005版)进行细菌耐药性监测。结果临床分离22 774株细菌中,革兰阴性菌占66．9％．革兰阳性菌占33．1％。84株肺炎链球菌中青霉素不敏感株约占61％,流感嗜血杆菌产酶率8．4％。金葡菌和凝固酶阴性葡萄球菌中耐甲氧西林株分别占69％(52％～93％)和82％(74％～95％)。未发现万古霉素耐药株。粪肠球菌和屎肠球菌对高浓度庆大霉素耐药率分别为61．4％和81．9％。上海地区发现3株耐万古霉素屎肠球菌,其中2株属VanA型耐药,1株为VanB型耐药。大肠埃希菌产ESBLs株检出率38．9％(20％～57％)、肺炎克雷伯菌和产酸克雷伯菌中为39．1％(13％～70％)。各种肠杆菌科细菌对亚胺培南、美罗培南仍高度敏感,耐药率0％～3％。铜绿假单胞菌和不动杆菌属对上述两种碳青霉烯类的耐药率均>30％,某些医院中出现了多重耐药株。不同地区、不同医院细菌耐药性各具特点,不同医院的同一菌种对同一药物的耐药率亦有很大差异。结论各医院开展细菌耐药性监测．对指导本单位合理选用抗菌药最具参考价值。在全国范围内按统一方案,同一方法和判断标准进行细菌耐药性监测对于正确合理选用抗菌药和控制细菌耐药性十分重要。

Objective To investigate the resistance of clinical isolates from hospitals in several regions of China, in 2005. Methods Eight representative general hospitals were involved in this program, bacterial susceptibility testing was carried out by means of a unified protocol using Kirby-bauer method, results were analyzed accordigg to CLSI/NCCLS 2005. Results Of 22 774 clinical isolates, gram negative bacilli and gram positive cocci accounted for 66, 9% and 33. 1% respectively. Nearly 61% of 84 strains of S. pneumoniae were penicillin non-susceptible. β lactamase-producing strains accounted for 8.4% in H. influenzae. The detection rates of methicillin-resistant staphylococci were 69% （52%-93%） in S. aureus and 82% （74%- 95 %） in coagulase negative staphylococci （CNS）, no vancomycin resistant strains were found. The resistant rates of E. faecalis and E. faecium against high level gentamicin （120 μg） were 61.4% and 81.9% respectively. Three strains of VRE were isolated in two Shanghai hospitals, 2 being VanA type and one VanB type. ESBLs- producing strains accounted for 38.9% （20%-57%） in E. coli and 39.1% （13%-70%） in Klebsiella spp. （K. pneumoniae and K. oxytoca）. Isolates of Enterobacteriaceae spp. were still highly sensitive to imipenem and meropenem, resistance rates being 0%-3%. However, the resistance rates of P. aeruginosa and Acinetobacter spp. strains to the above carbapenems were both 〉30%, moreover, in some hospitals a number of multiple drug resistant strains appeared. Bacterial resistance in different regions and different hospitals varied widely. Conclusions Surveillance data of bacterial resistance in each hospital is most important and valuable for the guidance of rational selection of antimicrobial agents in their own hospital. A nationwide surveillance of bacterial resistance system by means of a unified protocol is urgently needed for the rational use of antimicrobial agents and containment of bacterial resistance.