2005年上海瑞金医院细菌耐药性监测

Surveillance of antibiotic resistance in bacterial isolates from Shanghai Ruijin Hospital in 2005

目的了解2005年我院临床分离菌的分布和耐药特征,指导临床合理使用抗菌药物。方法采用纸片扩散法(K-B法)对我院临床分离的菌株进行药敏试验并对肠杆菌科细菌进行ESBL检测,按CLSI2005年标准判定药敏结果,用WHO-NET5.3软件进行数据分析。结果2005年我院共分离细菌3960株,其中革兰阴性杆菌2448株,占61.8%,革兰阳性球菌1512株,占38.2%。大肠埃希菌和金葡菌分别占革兰阴性杆菌和革兰阳性球菌的首位。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中ESBLs的检出率分别为39.5%、35.8%和6.6%。32.2%鲍曼不动杆菌和10.1%铜绿假单胞菌为泛耐药株(只对多黏菌素敏感);葡萄球菌属中MRSA和MRCNS的检出率分别为69.0%和80.4%;从肠球菌属中检出1株耐万古霉素的屎肠球菌。结论从我院住院患者分离的细菌耐药性比较严重,应该加强监测,指导临床合理使用抗菌药物。

Objective To investigate the distribution and antibiotic resistance profile of clinical isolates in Shanghai Ruijin Hospital during 2005. Methods Kirby-Bauer method was used to conduct susceptibility testing and ESBLs detection, The results were analyzed by WHONET 5.3 software according to CLS1 2005. Results Of the 3 960 clinical isolates, 61.8% （2 448/3 960） were gram-negative bacilli and 38.2% （1 512/3 960） were gram-positive cocci. E. coli was the most frequently isolated pathogen in gram-negative bacilli. Staphylococcus aureus was the most common pathogen in gram-positive cocci. About 69% of S. aureus isolates were MRSA, 80.4% of coagulase negative Staphylococcus isolates were methicillin-resistant. ESBLs were produced in 39.5% of E. coli, 35.8% of K. pneumoniae and 6.6% of Proteusmirabilis isolates respectively. About 10.1% of P. aeruginosa and 32.2% of A. baumannii isolates were panresistant strains （only sensitive to colistin）. A strain of vancomycin-resistant E. faecium was identified. Conclusions Antimicrobial resistance in clinical bacterial isolates is a very serious problem in Ruijin Hospital. Antimicrobial agents should be used rationally based on the results of susceptibility testing.