2005年武汉同济医院细菌耐药性监测

Surveillance of antimicrobial resistance in clinical isolates from Tongji Hospital in Wuhan in 2005

目的了解2005年华中科技大学同济医学院附属同济医院临床分离常见病原菌对常用抗菌药物耐药情况。方法采用纸片扩散法进行抗菌药物敏感性试验,以WHONET5.3软件分析数据。结果3119株临床分离病原菌中,前6位病原菌依次为大肠埃希菌、铜绿假单胞菌、凝固酶阴性葡萄球菌、克雷伯菌属、不动杆菌属和金葡菌。嗜麦芽窄食单胞菌居第10位。耐甲氧西林金葡菌、耐甲氧西林凝固酶阴性葡萄球菌检出率分别为53.7%、74.8%。未检出糖肽类耐药革兰阳性球菌。肠杆菌科细菌对碳青霉烯类、头孢哌酮-舒巴坦、哌拉西林-三唑巴坦、阿米卡星耐药率<30%;不发酵糖革兰阴性杆菌对碳青霉烯类、头孢哌酮-舒巴坦耐药率亦低于30%。产ESBLs大肠埃希菌和克雷伯菌属检出率分别为58.2%和44.4%。铜绿假单胞菌对头孢他啶、头孢吡肟及环丙沙星耐药率为26.6%～28.6%。嗜麦芽窄食单胞菌对替卡西林-克拉维酸、氟喹诺酮类、米诺环素耐药率较低。结论临床常见病原菌中革兰阴性杆菌约占2/3,碳青霉烯类对其抗菌活性最强。临床细菌对多数常用抗菌药物耐药率呈上升趋势。

Objective To investigate the resistance of clinical isolates to antimicrobial agents commonly used in Tongji Hospital during 2005. Methods Disk diffusion susceptibility test was used to determine the antimicrobial susceptibility. Data were analyzed by WHONET 5.3 software. Results A total of 3 119 clinical isolates were colleted. The top six pathogens were E. coli, P. aeruginosa, coagulase-negative Staphylococcus, Klebsiella spp, Acinetobacter spp. and S. aureus. S. maltophilia ranked tenth. About 53.7% of S. aureus isolates were identified as MRSA, 74.8% of coagulase-negative Staphylococcus isolates were MRCNS. No strain of gram-positive cocci was found resistant to glycopeptides. The resistance rates of Enterobacteriaceae to carbapenem, piperacillin-tazobactam, cefoperazone-sulbactam, amikacin were less than 30%. And not more than 30% of nonfermentative bacilli were resistant to carbapenem or cefoperazone-sulbactam. ESBLs-producing strains accounted for 58.2% in E. coli and 44.4% in Klebsiella spp. The resistance rates of P. aeruginosa to ceftazidime, cefepime, ciprofloxacin ranged from 26.6% to 28.60%. The resistance rates of S. maltophilia to the third generation cephalosporins, flaoroquinolones ticarcillin-clavulanic, and minocycline ranged from 6.2% to 22.7%. Conclusions Two thirds of these clinical isolates are gram-negative bacilli, for which carbapenems are highly active. The resistance to most antimicrobial agents is increasing in the clinical isolates from Tongji Hospital.