2007年上海地区细菌耐药性监测

Surveillance of bacterial resistance from hospitals in Shanghai in 2007

目的了解上海地区2007年14所医院临床分离株的耐药情况。方法采用纸片扩散法(K-B法)对临床分离株作药敏试验。以CLSI2007年版为判断标准。结果14所医院临床分离35907株细菌中革兰阳性菌占37.0%,革兰阴性菌占63.0%。耐甲氧西林金葡菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为61.1%和75.9%。未发现万古霉素中介株或耐药株。儿童患者中分离的肺炎链球菌青霉素敏感菌株占11.7%,青霉素不敏感株(PISP和PRSP)占88.3%(73.9%和14.4%)。发现2株万古霉素耐药屎肠球菌。产ESBLs的大肠埃希菌、克雷伯菌属和奇异变形杆菌在各菌属中分别占58.0%、53.9%和14.7%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为26.7%和18.8%。不动杆菌属对亚胺培南和美罗培南的耐药率分别为21.0%和22.5%。出现少数铜绿假单胞菌(2.8%)、鲍曼不动杆菌(4.5%)、弗劳地柠檬酸杆菌(6.0%)和肺炎克雷伯菌(0.1%)对现有抗菌药(除多黏菌素外)均耐药的泛耐药株。结论细菌耐药性仍呈增加趋势,加强对耐药菌的检测、耐药菌带菌者的筛查和耐药机制研究,对正确选用抗菌药和控制耐药菌感染十分重要。

Objective To investigate the resistance of clinical isolates in Shanghai hospitals from January to December in 2007. Methods Antimicrobial susceptibility testing of 35 907 clinicai isolates were carried out according to an agreed protocol using Kirby-Bauer （K-B）. Results were analyzed according to CLSI 2007. Results Of the 35907 clinical isolates, gram negative bacilli and gram positive cocci accounted for 63.0% and 37.0% respectively. The prevalence of MRSA was 61.1% in S. aureus. The prevalence of MRCNS was 75.9% in coagulase negative Staphylococcus. No vancomycin-intermediate S. aureus （VISA） or vancomycin-resistant S. aureus （VRSA） was identified. About 11.7% of the S. pneumoniae isolates from children were penicillin-susceptible （PSSP）. The remaining 88.3%（PISP 73.9% and PRSP 14.4%） of S. pneumoniae strains were nonsusceptible to penicillin. Two strains of vancomycin resistant Enterococcus （VRE） were identified in E. faeciurn. ESBLs-producing strains accounted for 58.0%, 53.9% and 14.7% in E. coli, Klebsiella spp. and P. rnirabilis, respectively. About 26.7% and 18.8% of the P. aeruginosa isolates were resistant to imipenem and meropenem respectively. And 21.0% and 22.5% of the Acinetabacter isolates were resistant to imipenem and meropenem respectively. Some pan-resistant isolates were found in P. aeruginosa （2.80%）, A. baumannii （5.5%）, C. freundii （6.0%） and K. pneumoniae （0.1%）. Conclusions Bacterial resistance is still on the rise. It is important to strengthen the detection of resistant bacteria in routine work, screen carriers of resistant bacteria, and take further steps to conduct research on the mechanism of antibiotic resistance, which are useful for rational use of antimicrobial agents and containment of bacterial resistance.