Mohnarin 2006～2007年度报告:14岁以下人群细菌耐药监测

2006～2007 Mohnarin report: Bacterial resistance in patients under 14 years old

目的了解我国14岁以下患儿细菌感染病原菌构成以及耐药情况。方法收集2006年6月1日至2007年5月30日84家医院上报的14岁以下患儿的临床分离菌株,常规鉴定和药敏试验。按CLSI 2006年版判断药敏试验结果,WHONET5.4分析结果。结果监测期间共收集5459株细菌,其中革兰阴性菌3330株,占61%;革兰阳性菌2129株,占39%。对青霉素不敏感的肺炎链球菌为92.1%,耐甲氧西林金葡菌和凝固酶阴性葡萄球菌分别为19.9%和86.9%,未发现耐万古霉素和替考拉宁的葡萄球菌。链球菌和葡萄球菌对大环内酯类药物的耐药率均>70%。粪肠球菌和屎肠球菌对高水平庆大霉素耐药率分别为41.7%和60.8%,各发现1株对万古霉素和替考拉宁耐药。大肠埃希菌和肺炎克雷伯菌的产超广谱β-内酰胺酶率分别为46.73%和50.36%。肠杆菌科细菌对碳青霉烯类药物仍高度敏感,对哌拉西林/三唑巴坦和头孢哌酮/舒巴坦也保持了较高的敏感率。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为28.7%和10.2%。鲍曼不动杆菌和嗜麦芽寡养单胞菌对头孢哌酮/舒巴坦的耐药率均<10%。结论对青霉素不敏感的肺炎链球菌比例增加明显,各分离菌种对β-内酰胺类和大环内酯类抗生素耐药率高,应引起高度重视。

Objective To investigate the bacterial distribution and resistance in patients under 14 years old. Methods Bacterial isolates from 84 Mohnarin member hospitals from June 1, 2006 to May 30, 2007 were collected. The isolation and identification of bacteria and bacterial susceptibility testing were carried out according to an agreed protocol. The bacterial susceptibility testing was judged by CLSI 2006 and WHONET 5.4 was employed for data process. Results A total of 5459 clinical strains were collected, of which Gram negative and Gram positive bacteria accounted for 61% and 39% respectively. The ratio of penicillin non-susceptible Streptococcus pneumonia was 92.1%. Methicillin resistant Staphyloccus aureus （MRSA） and coagulase-negative Staphylococcus （MRCNS） accounted for 19. 9% and 86.9% respectively. No staphylococcus was found resistant to vancomycin or teicoplanin. The resistantce rates of Streptococcus and Staphylococcus to macrolides were over 70%. 41.7% of Enterococcus faecalis and 60.8% of Enterococcus faecium were resistant to high concentration gentamicin. There was 1 strain found resistant to vancomycin and teicoplanin in E. faecalis and E. faecium respectively. About 46.73% of Escherichia coli and 50.36% of Klebsiellia pneumonia were ESBL-producing strains. Enterobacteriaceae were highly sensitive to imipenem and also showed higher susceptible to piperacillin/tazobactam and cefoperazone/sulbactam. The resistantce rates of Pseudomonas aeruginosa and Acinetobacter baumanii to imipenem were 28.7% and 10.2%, respectively. Less than 10% of A. baumanii and Stenotrophomonas maltophilia were resistant to cefoperazone/sulbactam. Conclusions Bacterial resistance rates were on the rise in child, especially the ratio of penicillin non-susceptible S. pneumonia and the bacterial resistantce rates to β-lactams and macrolides, which should be paid more attention.