2005年北京协和医院细菌耐药性监测

Surveillance of antibiotic resistance in clinical isolates from Peking Union Medical College Hospital during 2005

目的监测北京协和医院2005年临床分离株的耐药谱。方法收集患者首次非重复分离株4702株,其中革兰阴性菌63.2%,革兰阳性菌36.8%。以CLSI推荐的纸片扩散法测定其抗菌药物敏感性,用WHONET5.3软件分析结果。结果大肠埃希菌、肺炎克雷伯菌和产酸克雷伯菌对碳青霉烯类最敏感(99.7%～100%),其敏感率在80%以上的药物为哌拉西林-三唑巴坦、阿米卡星、头孢他啶和头孢西丁,而对头孢噻肟敏感率仅为48.9%～78.8%。肠杆菌属、柠檬酸杆菌属、沙雷菌属对碳青霉烯类、阿米卡星和头孢吡肟敏感率较高,为87.7%～100%,肠杆菌属和柠檬酸杆菌属对头孢西丁的耐药率分别为84.5%和50.0%,而沙雷菌属耐药率仅为12.5%,但有31.2%中介。铜绿假单胞菌对阿米卡星、美罗培南、亚胺培南、哌拉西林-三唑巴坦较敏感(70.5%～71.9%),对其他药物敏感率均低于65%。鲍曼不动杆菌对亚胺培南敏感率为70.7%,而对美罗培南敏感率仅为41.4%,对头孢哌酮-舒巴坦和氨苄西林-舒巴坦耐药率分别仅为25.1%和35.5%,对其他药物耐药率均高达58.5%～89.7%。所有葡萄球菌对万古霉素100%敏感,MRSA和MRCNS的检出率分别为57.9%和85.5%,MRSA对复方磺胺甲噁唑和MRCNS对利福平的敏感率均接近80%,对其他药物均较耐药。MSSA和MSCNS对头孢菌素类敏感率均在95%以上。屎肠球菌和粪肠球菌对万古霉素和替考拉宁最敏感(99.3%,98.3%),未检出耐万古霉素的肠球菌属。结论肠杆菌科细菌对碳青霉烯类仍最为敏感,但不发酵糖菌对其耐药率升高。葡萄球菌属和肠球菌属中均未发现耐万古霉素菌株。

Objective To investigate the antimicrobial resistance of clinical isolates in Peking Union Medical College Hospital during 2005. Methods A total of 4 702 nonduplicate isolates were collected, of which 63.20% were gram-negative strains and 36. 8% were gram-positive strains. The susceptibility was tested by disk diffusion method as recommended by CI.SI. All the data were analyzed by WHONET 5.3 software. Results About 99.7% to 100% of E. coli, K. pneumoniae and K. oxytoca isolates were susceptible to carbapenems. More than 80% of these isolates were susceptible to piperacillin-tazobactam, amikacin, ceftazidime and cefoxitin, but only 48. 9%-78. 8% were susceptible to cefotaxime. Higher percentage of Emerobacter spp. , Citrobacter spp. and Serratia spp. isolates （87. 7%-100%） was susceptible to carbapenems, amikacin and cefepime. The percentage of isolates resistant to cefoxitin was 84.50%, 50.0% and 12. 5% in Enterobacter spp. , Citrobacter spp. and Serratia spp. , respectively. Only 12.5% of Serratia isolates were resistant and 31.2% intermediate to cefoxitin. The percentage of P. aeruginosa susceptible to amikacin, meropenem, imipenem and piperacillin-tazobactam ranged from 70. 5% to 71.9%. All other antimicrobial agents tested only inhibited less than 650% of P. aeruginosa isolates. About 70. 7% of A. baumannii isolates were susceptible to imipenem, but only 41.4% to meropenem. Only 25.1% and 35.5% of A. baumannii isolates were resistant to cefoperazone-sulbactam and ampicillin-sulbactam, respectively. About 58.5 % to 89. 7% of the isolates were resistant to all other antimicrobial agents tested. Vancomycin inhibited all Staphylococcus isolates. About 57.9% of S. aureusand 85.50/oo of coagulase-negative Staphylococcus isolates were methicillin-resistant. Nearly 80% of MRSA strains were susceptible to trimethoprirrrsulfamethoxazole, and 800% of MRCNSsusceptible to rifampicin. Methicillin-resistant Staphylococcus isolates were highly resistant to all other antimicrobial agents. More than 95 % of MSSA and MSCNS strains were susceptible to cephalosporins. E. faecium and E. Jaecalis were most susceptible to vancomycin and teicoplanin. No vancomycin-resistant Enterococcus was identified. Conclusions Carbapenems are still the most active agents against Enterobacteriaceae strains. Non-fermenting bacteria are relatively resistant to carbapenems. None of Staphylococcus or Entero- coccus isolates is found resistant to vancomycin.