Mohnarin 2006～2007年度报告:革兰阳性菌耐药监测结果

2006～2007 Mohnarin report: Results of Gram positive bacteria resistance

目的了解我国细菌感染患者革兰阳性致病菌耐药状况。方法采用纸片法、MIC法或E-test法测定细菌对抗菌药物敏感性，用WHONET5．4软件进行数据分析，对卫生部全国细菌耐药性监测网（Mohnarin）所属84家三级甲等医院2006年6月1日～2007年5月31日分离的革兰阳性细菌药物敏感性结果进行分析。结果①共收集革兰阳性菌28741株，包括葡萄球菌18689株，肠球菌6878株，链球菌2767株和其它革兰阳性菌407株；②头孢西丁耐药的金葡菌和凝固酶阴性葡萄球菌的检出率分别为61．6％和83．8％，未发现对万古霉素耐药的金葡菌和凝固酶阴性葡萄球菌；③用1μg的苯唑西林纸片计算肺炎链球菌对青霉素的不敏感率为56．9％；④粪肠球菌和屎肠球菌中分别有1．3％和3．4％对万古霉素耐药，1．2％和3．2％对替考拉宁耐药；⑤革兰阳性球菌对大环内酯类耐药明显。结论我国革兰阳性菌耐药呈明显上升趋势，青霉素不敏感肺炎链球菌、MRSA检出率高；革兰阳性球菌对大环内酯类耐药明显。

Objective To determine Gram positive bacterial distribution and resistance in China. Methods Disc diffusion test, MIC test and E-test were used to detect the antimicrobial sensitivity of Gram positive bacteria isolated from clinical specimen. WHONET 5.4 was applied for analysis the bacterial sensitive data from 84 tertiary Mohnarin member hospitals at different area in China from June 1, 2006 to May 31, 2007. Results （1） Totally, 28,741 Gram positive bacteria were collected during the survey period, which included Staphylococcus 18,689 strains, Enterococcus 6,878 strains, Streptococcus 2,767 strains and other Gram positive bacteria 407 strains. （2） 61.6% and 83.8% of Staphylococcus aureus and coagulase-negative Staphylococci were methicillin-resistant （MRS）, respectively. No Staphylococcus strain was resistant to vancomycin. （3） The detection rates of penicillin non-susceptible Streptococcus pneumoniae （PNSSP） tested by 1μg oxacillin disc was 56.9%. （4） The resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin （VRE） were 1.3% and 3.4%, while to teicoplanin were 1.2% and 3. 2%, respectively. （5） Macrolide-resistance in Gram positive cocci was severe. Conclusion The antimicrobial resistance of Gram positive bacteria in China was increasing with higher isolate rates of MRSA, PNSSP and VRE. All the investigated Gram positive cocci were highly resistant to macrolides.