2005年上海华山医院细菌耐药性监测

Surveillance of antibiotic resistance in clinical isolates from Shanghai Huashan Hospital in 2005

目的了解上海华山医院2005年临床分离菌对各类抗菌药物的耐药性。方法纸片扩散法(Kirby-Bauer法)检测临床分离菌对各类抗菌药物的敏感性,判断标准参照2005年版CLSI文件。结果临床分离3896株细菌中,革兰阴性菌占68.1%,革兰阳性菌占31.9%。金葡菌和凝固酶阴性葡萄球菌中耐甲氧西林株分别占93.2%(465/499)和95.2%(260/273)。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67.4%和82.8%。发现2株耐万古霉素屎肠球菌,均为VanA型耐药。大肠埃希菌产ESBLs株检出率47.6%(206/433),肺炎克雷伯菌和产酸克雷伯菌中产ESBLs株为69.6%(391/562)。各种肠杆菌科细菌对亚胺培南、美罗培南仍高度敏感,除柠檬酸杆菌属对两者的耐药率均为9.1%外,其余均在0～4%之间。铜绿假单胞菌对上述碳青霉烯类的耐药率分别为39.3%和56.9%。结论甲氧西林耐药葡萄球菌(MRSA和MRCNS)、大肠埃希菌和克雷伯菌属中产ESBLs菌株的检出率高,发现2株糖肽类耐药的屎肠球菌。开展细菌耐药性监测,对指导本单位合理选用抗菌药具重要参考价值。

Objective To investigate the resistance of clinical isolates from Shanghai Huashan Hospital in 2005. Methods Antimicrobial susceptibility test was carried out by Kirby-Bauer method. Results were analyzed according to CLSI 2005. Results Of the 3 896 clinical isolates, gram negative bacilli and gram positive cocci accounted for 68.1% and 31.9% respectively. About 93.2 % （465/499） of S. aureus isolates were identified as methicillin-resistant Staphylococcus, 94.90/00 （260/274） of coagulase negative Staphylococcus （CNS） isolates were methicillin-resistant. No vancomycin-resistant strain was found. The resistance rates of E. faecalis and E. faecium to high level gentamicin （120 μg） were 67.4% and 82.8% respectively. Two strains of VRE were isolated. Both were VanA type. ESBLs- producing strains accounted for 47.6% （206/433） in E. coli and 69.6% （391/562） in Klebsiella spp （K. pneumoniae and K. oxytoca）. Isolates of Enterobacteriaceae were still highly sensitive to imipenem and meropenem, resistance rates being 0 -4% except Citrobacter isolates, 9.1% of which were resistant. However, 39. 3% and 59. 6% of P. aeruginosa strains were resistant to the above carbapenems, respectively. Conclusions The prevalence of MRSA and MRCNS is very high. ESBLs are prevalent in E. coli and Klebsiella spp. Two glycopeptideresistant E. faecium isolates are identified firstly in Huashan Hospital. Our data will be useful for rational use of antimicrobial agents in the treatment of bacterial infections.