中国教学医院细菌耐药监测研究及现状介绍

Introduction current situation and research of antimicrobiai resistance surveillance in teaching hospitals of China

目的介绍我国不同地区教学医院分离的社区和院内常见病原菌的耐药性。方法分析来自中国6个耐药监测网的耐药信息,评价细菌耐药性的年度变化。结果监测结果均显示,革兰阴性菌的检出率高于革兰阳性菌;大肠埃希菌和克雷伯菌的最主要耐药机制是产超广谱β内酰胺酶(ESBLs);对于易产AmpC酶的菌株,如阴沟肠杆菌、产气肠杆菌、枸橼酸杆菌,体外药敏试验显示,碳青酶烯类药物敏感性最高,继之为第4代头孢菌素和阿米卡星;近年来,产AmpC的大肠杆菌和肺炎克雷伯菌和对碳青酶烯类药物敏感性降低的肠杆菌科菌,已出现并有增多的趋势;对铜绿假单胞菌和鲍曼不动杆菌,敏感率最高的为多粘菌素B;多重耐药铜绿假单胞菌和鲍曼不动杆菌(MDRP)发生率在2003—2006年约为15%～20%和33%～54%;甲氧西林耐药葡萄球菌(MRSA)的发生率约为全部金葡菌的48%～69.2%;不同地区的MRSA有较大差异;国内万古霉素耐药肠球菌的发生率低于5%。结论中国教学医院的细菌耐药现状日益严重,需做好细菌耐药性监测工作。

Objective To investigate antimicrobial resistance among nosocomial and community - acquired pathogens from teaching hospitals located at different areas in China. Methods To analyze the data from 6 antimicrobial surveillance program and evaluate the yearly change of resistant situation. Results The incidence of gram - negative bacteria is higher than gram -positive bacteria. The main resistant mechanism in Escherichia coli and Klebsiella spp is extended - spectrum beta - lactamas- es （ESBLs）. For AmpC - producing species such as Enterobacter cloace, Enterobacter aerogenes and Citrobacter spp, the susceptibility percentage of carbapenem is highest, followed by the fourth generation eephalosporin and amikacin. In recent years, AmpC - producing Escherichia coli and Klebsiella pneumoniae and earbapenem - non - susceptible Enterobacteriaceae has emerged. The most susceptible antibiotic against Pseudomonas aeruginosa and Acinetobacter baomannii is polymixin B. The incidence of muhidrug- resistant Pseudomonas aeruginosa and Acinetobacter baomannil （MDRP） is 15% - 20% and 33% - 54% in 2003 - 2006 separately. The Methicillin - resistant staphylococcus aureus （ MRSA ） percentage in staphylococcus aureus is 48% -69%. The incidence of vaneomycin -resistant enterococci is less than 5 %. Conclusion The drug -resistant bacteria in teaching hospitals in China is quite a big problem. More attention should be paid on antimicrobial resistant surveillance.