Mohnarin 2006～2007年度报告:西北地区细菌耐药监测

2006～2007 Mohnarin report:Bacterial distribution and resistance in north west China

目的总结西北地区10家教学医院2006-2007年度临床分离病原菌的耐药状况。方法常规方法培养分离医院内感染病原菌，并应用半自动或全自动细菌鉴定分析仪鉴定到种，药敏试验方法按CLSI规定的标准进行。监测数据按卫生部全国细菌耐药监测（Mohnarin）中心设计方案的要求定期上报。采用WHONET5．4软件进行数据统计分析。结果西北地区10家教学医院共分离病原菌株14608株，其中革兰阴性菌10098株占分离菌的69．13％，革兰阳性菌4091株占分离菌的28．01％，真菌396株占分离菌的2．71％。大肠埃希菌超广谱p内酰胺酶的产酶率为（1380／2021）68．28％，肺炎克雷伯菌产酶率为（455／1008）45．14％，大肠埃希菌对左氧氟沙星和环丙沙性的耐药率为63．00％～87．50％，铜绿假单胞菌、鲍曼不动杆菌为32．90％～68．40％。革兰阳性球菌中耐甲氧西林的金葡菌的发生率为43．82％，耐甲氧西林的表葡菌的发生率为60．97％。未发现耐万古霉索的葡萄球菌。粪肠球菌对替考拉宁和万古霉素耐药率分别为3．20％、1．50％，屎肠球菌对替考拉宁和万古霉素耐药率分别为5．7％、3．2％。结论碳青霉烯类、哌拉西林／三唑巴坦、阿米卡星和头孢吡肟对医院内感染分离的肠杆菌仍有较好的抗菌活性，大肠杆菌对氟喹诺酮类药物的耐药性越来越高，值得临床重视，应限制该类药物的临床应用范围。非发酵菌对临床常用抗菌药物普遍敏感性降低。耐甲氧西林葡萄球菌和耐万古霉素的屎肠球菌感染是抗菌药物治疗中的难点。临床微生物实验室应加强对产酶菌和多重耐药菌的监测，为临床正确合理使用抗菌药物提供依据。

Objective To summarize 2006-2007 annual drug resistance of clinical isolates in northwest of China with ten teaching hospital. Methods Isolates were cultured by routine method and identified by the semi-automatic or automatic bacteria analysis system. Drug susceptibility test was according to CLSI standards. Supervising data delivered to MOH National Antimicrobial Resistant Investigation Net （Mohnarin） according to its plan. Data statistic and analysis used WHONETS. 4 software. Results From 14,608 strains pathogens, Gram negative bacteria had 10098 strains （69.13%）, Gram positive bacteria had 4091 strains （28.01%）, fungus had 396 strains （2.71%）. The positive ratio of producing ESBLs E. coli was 68.28% （1380/2021）, ESBLs-Klebsiella pneurnoninae was 45.14% （455/1008）. The drug resistance rates of E. coli against ciprofloxacin and levofloxacin were 63.00%-87.50%, Pseudomonas aeruginosa and Acinetobacter baurnannii were 32.90%-68.40%. MRSA were 43.82%, MRCNS were 60.97%. Vancomycin resistant Staphy-lococcus didn＇t detect. The drug resistance rates of Enterococcus faecalis against teicoplanin and vancomycin were 3.20% and 1.50%. Enterococcus faecius were 5.70% and 3.20%. Conclusions Enterobacteriaceae against carhapenems, piperacillin/tazobactam, amikacin and cefpirome had good antibacterial activity in noso- comial infection. Resistance of E. coli against fluoroquinolones was more and more higher, which should control quinolones using in clinical limits, susceptibility of non-fermenters against clinical commonly used antimi-crobial agents were lower gradually. Infaction caused by MRSA and vancomycin resistant Entarococcus faecium were difficult question to treatment. Drug resistance of enzyme-producing and multi-resistant bacteria should enhance supervisison, in order to provide help to clinic with correct using antimierobials, nationally.