2006年上海地区细菌耐药性监测

Surveillance of bacterial resistance in Shanghai hospitals during 2006

目的了解上海地区2006年14所医院临床分离株的耐药情况。方法采用纸片扩散法(KB法)和CLSI2006年的判断标准对31316株临床分离株作药敏试验。结果31316株细菌中革兰阳性菌占36.4%,革兰阴性菌占63.6%。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为64.6%和82.2%。未发现万古霉素中介株(VISA)或耐药株(VRSA)。青霉素敏感肺炎链球菌(PSSP)成人患者和儿童患者中的检出率分别为96.0%和13.0%,青霉素不敏感株(包括PISP和PRSP)的检出率儿童中分别为73.2%和13.8%,成人中分别为4%和0。发现3株万古霉素耐药屎肠球菌。在大肠埃希菌、克雷伯菌属和奇异变形杆菌中产ESBLs菌的检出率分别为53.0%、51.1%和19.5%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率为24.4%和15.5%。不动杆菌属对亚胺培南和美罗培南的耐药率为15.5%和17.0%。出现少数铜绿假单胞菌(2.7%)、鲍曼不动杆菌(3.4%)和弗劳地柠檬酸杆菌(7.2%)的泛耐药株。结论细菌耐药性持续增加,出现泛耐药的铜绿假单胞菌、鲍曼不动杆菌和弗劳地柠檬酸杆菌,加强细菌耐药性监测,对于正确合理选用抗菌药和控制细菌耐药性产生十分重要。

Objective To investigate the resistance of clinical isolates in Shanghai hospitals from January through December in 2006. Methods Antimicrobial susceptibility testing of 31 316 clinical isolates were carried out by means of Kirby-Bauer （KB） method. Results Of the 31 316 clinical isolates, gram-negative bacilli and gram-positive cocci accounted for 63.6% and 36.4% respectively. About 64.6% of S. aureus and 82.2% of coagulase negative Staphylococcus isolates were identified as methicillin-resistant. No VISA or VRSA isolate was found. Majority （96.0 %） of the S. pneumoniae isolates from adults were penicillin-susceptible （PSSP）, but only 13.0% of the S. pneumoniae isolates from children were PSSP. Most of the S. pneumoniae from children were penicillin-nonsusceptible （PISP＋ PRSP） 1-87.0% （PISP 73.2% and PRSP 13.8%）]. Only 4.0% （PISP 4. 0% and PRSP 0） of the S. pneumoniae from adults were penicillin-nonsusceptible. Three strains of E. faecium were identified as vancomycin-resistant （VRE）. The prevalence of ESBLs-producing strains in E. colt, Klebsiella spp. and P. mirabilis isolates was 53.0 %, 51.1% and 19.5 % respectively. The resistance rates of P.＂ aeruginosa to imipenem and meropenem were 24.4% and 15.5% respectively and 15.5% and 17.0% for Acinetobacter spp. respectively. Some panresistant isolates of P. aeruginosa （2.70/00）, A. baumannii （3.4%） and C. freundii emerged. Conclusions The emerging bacterial resistance and pandrug resistance in P. aeruginosa, A. baumannii, and C. freundii warrants further enhancing the surveillance of bacterial resistance and characterization of panresistance mechanism to inform the rational use of antimicrobial agents and containment of bacterial resistance.