2005年我国五家教学医院革兰阳性球菌耐药监测研究

Antimicrobial resistance surveillance of gram-positive cocci isolated from 5 teaching hospitals in China in 2005

目的调查2005年我国革兰阳性球菌的耐药现状与监测方法收集2005年8月至12月五家教学医院连续分离的非重复的460株革兰阳性球菌。采用琼脂稀释法测定药物的最低抑菌浓度(MICs)。结果80株肺炎链球菌中,青霉素中介(PISP)和青霉素耐药(PRSP)株的发生率分别为25·0%、21·2%。PRSP和PISP的发生率最高的是杭州(分别为55·6%、11·1%),其次是上海(16·7%、27·8%),再次为北京(5·6%、27·8%)、武汉(5%、20%)。替考拉宁和万古霉素对这80株菌的活性最高(100%敏感),其次是莫西沙星(96·2%)、左氧氟沙星(91·2%)和阿莫西林/克拉维酸(85%),红霉素、克林霉素、四环素、甲氧苄啶/磺胺甲唑敏感性低于26·2%。苯唑西林耐药的金黄色葡萄球菌(MRSA)和苯唑西林耐药的凝固酶阴性葡萄球菌(MRSCoN)的发生率分别为51·3%和77·4%。MRSA的发生率最高的是上海(78·4%)、杭州(60·0%),其次为沈阳(45·9%)、北京(40·0%)和武汉(33·3%)。对于MRSA,活性较高的药物为氯霉素(69·4%)、利福平(68·4%)和甲氧苄啶/磺胺甲唑(63·3%)。粪肠球菌对青霉素、氨苄西林的敏感性(85%以上)高于屎肠球菌(20%);53%的粪肠球菌和25·5%的屎肠球菌对庆大霉素高水平耐药。所有金葡菌、CoNS、肠球菌属对万古霉素、替考拉宁敏感。结论不同地区革兰阳性球菌的耐药性有所差异。替考拉宁和万古霉素对革兰阳性球菌的活性非常高。Antimicrobialresistancesurveillanceofgram-positivecocc*

Objective To investigate antimicrobial resistance among gram-positive cocci in China in 2005. Methods From August to December 2005,460 consecutive and non-repetitive gram-positive bacteria were collected from 5 teaching hospitals. The minimal inhibitory concentrations （MICs） of antibacterial agents were determined by agar dilution method. Results The prevalence of penicillin-intermediate （PISP） and penicillin-resistant Streptococcus pneumoniae （PRSP） was 25.0% and 21.2%, respectively. The prevalence of PRSP and PISP were the highest in Hangzhou （55.6% and 11.1% ） and Shanghai （ 16.7% and 27. 8% ） , followed by Beijing （5.6% and 27.8% ） and Wuhan （5% and 20% ）. Teicoplanin and vancomycin were the most active agents against S. pneumoniae （susceptible rate, 100% ）, followed by moxifloxacin （ 96.2% ）, levofloxacin （ 91.2% ）, amoxicillin/clavulanic acid （ 85% ） . Susceptibility to erythromycin, clindamycin, tetracycline, and trimethoprim/sulfamethoxazole was lower than 26. 2%. The prevalence of methicillin-resistant Staphylococcus aureus （MRSA） and methicillin-resistant coagulasenegative Staphylococci （MRSCoNS） was 51.3% and 77.4%, respectively. The prevalence of MRSA was the highest in Shanghai （ 78.4% ） and Hangzhou （ 60. 0% ） , followed by Shenyang （ 45.9% ） , Beijing （40. 0% ） and Wuhan （33.3%）. About 70% of strains were susceptible to chloramphenicol, followed by rifampin （68.4%） and trimethoprim/sulfamethoxazole （63.3%）. E. faecalis were more susceptible to penicillin and ampicillin （ 〉 85% ） than E. faecium （ 20% ） ; 53% of E. faecalis and 25.5% of E. faecium were resistant to high level gentamicin. All isolates of S. aureus, CoNS and Enterococci tested were susceptible to vancomycin and teicoplanin. Conclusions Antimicrobial resistance patterns differed at regions. Teicoplanin and vancomycin were the most active against gram-positive bacteria tested.