2006-2007年Mohnarin胆汁培养病原菌构成与耐药性分析

Mohnarin Report 2006-2007:Bacterial Distribution and Resistance in Biliary Tract Infections

目的了解胆道感染病原菌分布和病原菌耐药情况，供临床抗菌药物选择参考。方法按照卫生部全国细菌耐药性监测网（Mohnarin）统一方案，对84昕医院9006年6月1日-2007年5月31日，胆汁培养病原菌进行药敏测定，利用WHONET软件进行数据分析。结果共分离1441株病原菌，其中革兰阴性菌952株，占66．1％，前3位依次为大肠埃希菌31．0％、肺炎克雷伯菌8．4％、铜绿假单胞菌7．8％；革兰阳性菌489株，占33．9％，前3位依次为粪肠球菌11．6％、屎肠球菌9．5Yoo、葡萄球菌属7．4％；药敏结果显示，大肠埃希菌和肺炎克雷伯菌对三代头孢菌素耐药率为25．9％～70．0％、17．9％～44．8％，对喹诺酮类耐药率为66．9％～70．9％、34．6oA～40．0％，与同期整体病原菌耐药监测结果相似，铜绿假单胞菌对亚胺培南、头孢哌酮／舒巴坦耐药率分别为37．5％、13．8％；耐甲氧西林金黄色葡萄球菌比率为78．6％，高于同期监测整体结果，耐糖肽类肠球菌分离率较低。结论胆道感染病原菌分布仍然以革兰阴性菌为主，但分布较为广泛；常见病原菌对多种抗菌药物耐药明显，耐甲氧西林金黄色葡萄球菌（MRSA）比例高，临床抗菌药物使用应谨慎、合理。

OBJECTIVE To determine the bacterial distribution and resistance of biliary tract infections in China. METHODS Disc diffusion test, MIC test or E-test were used to detect the antimicrobial sensitivity of bacterial isolates from bile specimens. WHONET software was applied for analysis of the bacterial sensitive data from 84 tertiary Mohnarin member hospitals at different area in China from June 1, 2006 to May 31, 2007. RESULTS A total of 1441 bacterial strains were collected in the survey period, which included 952 Gram-negative strains （66.1%） , of which the top three were Escherichia coli （31.0%） ,Klebsiella pneumoniae （8.4%） and Pseudo- monasaeruginosa （7.8%） and 489 Gram-positive strains （33. 9%）, the top three were Enterococcus faecalis （11.6M）, E. faecium （9.5%） and Staphylococcus （ 7.4 %）. Susceptibility results showed that the resistant rates of E. coli and K. pneumoniae to three generation cephalosporins and quinolones were 25. 9-70.0%, 17.9- 44.8% and 66.9-70.9%, 34.6-40.0%, respectively, which were comparable with the results of overall bacteria collection. The resistant rates of P. aeruginosa to imipenem and cefoperazone/sulbactam were 37.5 %, 13.8%, and the detection rate of meticillin-resistant Staphylococcus aureus （MRSA） from bile samples was higher than the results of overall bacteria collection. Vancomycin-resistant Enterococcus （VRE） were rare. CONCLUSIONS Gram- negative bacilli are still the predominant pathogens in biliary tract infections l the overall bacterial resistance is severe. MRSA is increasing. Prudent application of antibiotics in biliary tract infections needs to be emphasized.