2006年中国七家教学医院革兰阳性球菌耐药性研究

Antimicrobial resistance surveillance of gram-positive cocci isolated from 7 teaching hospitals in China in 2006

目的调查2006年我国革兰阳性球菌的耐药性。方法收集2006年6—12月全国7家教学医院分离的非重复革兰阳性菌674株，以琼脂稀释法测定抗菌药物的MIC。结果100株肺炎链球菌中，青霉素耐药的肺炎链球菌（PRSP）和青霉素中介的肺炎链球菌（PISP）分别占1％和19％。所有肺炎链球菌均对万古霉素和替考拉宁高度敏感；对左氧氟沙星和莫西沙星的敏感率分别为97％和98％；对阿莫西林／克拉维酸、头孢曲松和氯霉素的敏感率依次为96％、87％和73％；青霉素敏感的肺炎链球菌（PSSP）全部对头孢丙烯和头孢克罗的敏感率分别为62．0％和55．7％，而PISP和PRSP对这2种抗菌药物均耐药；所有肺炎链球菌对大环内酯类、甲氧苄啶／磺胺甲嚼唑（TMPCo）和四环素的敏感率均小于35％。金黄色葡萄球菌和凝固酶阴性葡萄球菌（SCON）中耐甲氧西林菌株分别占48％（33％-84％）和81％（69％～94％）。耐甲氧西林金黄色葡萄球菌（MRSA）对TMPCo、氯霉素和利福平敏感率分别为72％、66％和45％；对大环内脂类、氨基糖苷类、四环素和氟喹诺酮类的敏感率低于18％。粪肠球菌和屎肠球菌对高浓度庆大霉素耐药率分别为56％（30％～86％）和80％（50％-100％）。未发现对万古霉素和替考拉宁耐药的葡萄球菌和粪肠球菌；但在杭州发现对该2种抗菌药物同时耐药的屎肠球菌。除氯霉素和四环素外，粪肠球菌对其他所测抗菌药物的敏感率均高于屎肠球菌。结论各地区革兰阳性耐药性有所差异，且对大部分抗菌药物的耐药率较2005年本项目的监测结果有所升高。替考拉宁和万古霉素对革兰阳性球菌仍保持很高的抗菌活性。

[ Abstract] Objective To investigate antimicrobial resistance among gram-positive cocci in China in 2006. Methods From Jun 2006 to Dee 2006,674 consecutive and non-repetitive gram-positive bacteria were collected from 7 teaching hospitals. The minimal inhibitory concentration （MICs） of antibacterial agents were determined by agar dilution method. Results The prevalence of penicillin-resistant （PRSP） and penicillin- intermediate S. pneumoniae （PISP） among 100 isolates was 1% and 19%, respectively. Teieoplanin and vancomycin were the most active agents against S. pneumoniae. 97% and 98% S. pneumoniae isolates were susceptible to levofloxaein and moxifloxaein, respectively. The susceptibility of amoxieillin/elavulanie acid, eeftriaxone and ehloramphenieol are 96% , 87% and 73% , respectively. The susceptible rates of penicillin- susceptible S. pneumoniae （PSSP） to eefprozil and eefaelor were 62% and 55.7%, respectively. All the PISP and PRSP isolates were resistance to the two antibiotics. The susceptibility to maerolides, trimethoprim/ sulfamethoxazole and tetracycline was lower than 35 %. The prevalence of methieillin-resistant Staphylococcus aureus （MRSA） and methieillin-resistant eoagulase-negative Staphylococci （MRSCON） was 48% （33%-84%） and 81% （69%-94%）, respectively. The susceptible rates of MRSA to trimethoprim/ sulfamethoxazole, chloramphenicol, rifampin, and the other antibiotics in this study were 72% , 66% and 45%, respectively. The susceptible rate of MRSA to marcrolides, aminoglycosides, tetracyclines and quinolones were not more than 18%. 56% （30%-86% ）of E. faecalis and 80% （50%-100% ）of E. faecium were highly resistant to gentamicin. The susceptibility of E. faecalis to all the antibiotics except chloramphenicol and tetracycline were higher than E. faecium. All isolates of S. aureus, CoNS and E. faecalis tested were susceptible to vacomycin and teicoplanin. There were two vacomycin-resistant E. faecium strains isolated from Hangzhou. Conclusions Antimicrobial resistance patterns of gram-positive cocci differed in different regions. The resistance of gram-positive cocci to the antibiotics in this study this year was a little higher than the data of the year of 2005. Teicoplanin and vancomycin remained very high activity to gram-positive cocci.