2005年浙江大学医学院附属第一医院细菌耐药性监测

Surveillance of antibiotic resistance in clinical isolates from First Affiliated Hospital of Zhejiang University Medical College in 2005

目的分析浙江大学医学院附属第一医院2005年临床分离细菌对抗菌药物的耐药性。方法采用Kirby-Bauer(KB)法对4551株临床分离菌进行药敏试验,结果按CLSI2005年版标准判断及采用WHONET5.3软件进行统计分析。结果4551株细菌中革兰阴性菌3012株(66.2%),革兰阳性菌1539株(33.8%),不发酵糖菌占阴性菌的55.2%。MRSA和MRCNS检出率分别为68.6%和86.5%,未检测到万古霉素耐药株,也未发现万古霉素、替考拉宁耐药的粪肠球菌和屎肠球菌。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌ESBLs的发生率分别为55.8%、43.5%和9.1%,亚胺培南和美罗培南对肠杆菌科细菌仍保持较高的敏感性(>96%)。鲍曼不动杆菌仅对头孢哌酮-舒巴坦的耐药率相对较低,为35.7%,对亚胺培南和美罗培南的耐药率高达66.1%。铜绿假单胞菌对阿米卡星耐药率最低,为14.7%,其次为头孢他啶、头孢吡肟、头孢哌酮-舒巴坦和氨曲南(23%～29%),对美罗培南的耐药率为25.2%,低于亚胺培南的33.4%。米诺环素对嗜麦芽窄食单胞菌、脑膜炎败血性黄杆菌、洋葱伯克霍尔德菌有较好的抗菌活性(细菌对其耐药率<10%)。结论我院临床分离细菌特别是鲍曼不动杆菌耐药性较为严重,应引起重视。

Objective To investigate the antibiotic resistance in clinical isolates from First Affiliated Hospital of Zhejiang University Medical College in 2005. Methods Antimicrobial susceptibility testing was carried out by means of Kirby Bauer （KB） technique. The data were analyzed by WHONET 5.3 software. Results Of the 4 551 clinical isolates collected, 66.2% were gram-negative bacilli and 33.80% were gram-positive cocci. Nonfermentative gram negative strains accounted for 55.2% of all gram-positive isolates. About 68.6 % of Staphylococcus aureus were methicillin-resistant （MRSA）, and 86.8% of coagulase negative Staphylococcus isolates were methicillin-resistant （MRCNS）. No vancomycin- or teicoplanin-resistant isolate was found in Staphylococcus, Enterococcus faecalis or Enterococcus faecium. The prevalence of extended- spectrum β- lactamases （ESBLs） was 55.8% in E. toll, 43.5% in K. pneumoniae and 9.1 % in Proteusrnirabilis. Imipenem and meropenem were the most potent antimicrobial agents against Enterobacteriaceae （〉96 % ）. About 35.7 % of Acinetobacter baumannii isolates were resistant to cefoperazone-sulbactam, while more than 60% of the isolates were resistant to imipenem or meropenem. The resistance rate of P. aeruginosa was lowest to amikacin （14.7%）, followed by ceftazidime, cefepime, cefoperazone-sulbactam and aztreonam （23 %-29 % ）. More strains were resistant to imipenem （33.4 % ） than to meropenem （25.2 % ）. Minocycline showed good activity against Stenotrophornonas maltophilia, Chryseobacterium meningosepticum and Burkholderia cepacia （resistance in 〈10 % of the strains）. Conclusions Special attention should be paid to the serious antimierobial resistance in non fermenting gram-negative bacilli, especially A. baurnannii.