2007年广州地区耐药性监测分析

Surveillance of antimicrobial resistance in Guangzhou hospitals in 2007

目的了解广州地区2007年细菌耐药性监测协作组所属15所医院临床分离株的耐药情况，明确广州地区的耐药特点。方法采用纸片扩散法（KB法）和美国临床和实验室标准协会（CISI）2008年的判断标准对18500株临床分离株作药敏试验。结果18500株细菌中革兰阳性菌占31．6％，革兰阴性菌占68．4％，其中非发酵菌占革兰阴性菌45．7％。耐甲氧西林金葡菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为55．9％和75．9％。按照2008年CLSI标准，所有肺炎链球菌都对青霉素敏感。在大肠埃希菌和克雷伯菌属中产ESBLs菌的检出率分别为43．8％和39．8％，对大肠埃希菌和克雷伯菌属ESBL产生菌的耐药率最低的药物分别是美罗培南、亚胺培南、头孢哌酮／舒巴坦和哌拉西彬他唑巴坦，耐药率为0—14．1％。铜绿假单胞菌对头孢哌酮／舒巴坦、哌拉西林／他唑巴坦和美罗培南的耐药率最低，分别为20．4％、24．4％和25．4％，但3者敏感率相比，由高到低分别为：哌拉西彬他唑巴坦（75．4％）、美罗培南（72．4％）和头孢哌酮／舒巴坦（63．2％）。不动杆菌属对头孢哌酮／舒巴坦和美罗培南的耐药率分别为2．6％和5．1％。出现少数铜绿假单胞菌（5．5％）和鲍曼不动杆菌（1．5％）的泛耐药株。痰标本来源的铜绿假单胞菌和鲍曼不动杆菌对大多抗菌药物的耐药性都高于血液标本来源菌。结论非发酵菌分离率上升，细菌耐药性持续增加，出现泛耐药的铜绿假单胞菌和鲍曼不动杆菌。加强地区性细菌耐药性监测，对于正确合理选用抗菌药和控制细菌耐药性产生十分重要。

Objective To investigate antimicrobial resistance of clinical isolates from 15 hospitals submitted to Guangzhou Surveillance of Antimicrobial Resistance （GSAR） in 2007, and to learn the feature of bacterial resistance in Guangzhou. Methods Disc diffusion test （ K-B methods） was employed to study the antimicrobial resistance. Results Of 18 500 clinical isolates, Gram negative bacilli and Gram positive cocci accounted for 68.4% and 31.6%, respectively,and 45.7% isolates in Gram negative bacilli belonged to non-fermentative bacilli. The detection rates of methicillin-resistant strains was 55.9% in Staphylococcus aureus and 75.9% in coagulase negative Staphylococcus. All of the Staphylococcus pneumoniae isolates were penicillin-susceptible （PSSP） according to 2008 CLSI criterion. One strains of Enterobacter faecium were identified as vancomycin-resistance （VRE）. The resistant rates of Enterobacter to imipenem and merpenem were the lowest. The prevalence of ESBLs-producing strains in Enterobacter coli and Klebsiella spp. isolates was 43.8% and 39. 8%, respectively. Against all the ESBLs strains in Enterobacter coli and Klebsiella spp, meropenem, imipenem, cefoperazone/sulbactam, and piperacillin/tazobactam showed the lowest resistant rates, ranging from 0 to 14. 1% , 20. 4% , 24.4% and 25.4% isolates of Pseudomonas aeruginosa were resistant to efoperazone/sulbactam, piperacillin/tazobactam and meropenem, while 75.6%, 72. 4% and 63.2% isolates of Pseudomonas aeruginosa were susceptible to piperacillin/tazobactam, meropenem and cefoperazone/sulbactam, respectively. The resistance rates of Acinetobacter spp. to cefoperazone/sulbactam and meropenem were 2. 6% and 5. 1% , respectively. Some panresistant isolates of Pseudomonas aeruginosa （5.5%） and Acinetobacter baumannii （ 1.5% ） emerged. The resistance of Pseudomonas aeruginosa and Acinetobacter baumannii isolated from sputum sample was higher than those from blood sample. Conclusions The increase of isolated rates of non-fermentative Gram-negative bacilli and the emerging bacterial resistance and pandrug resistance in Pseudomonas aeruginosa and Acinetobacter baumannii warrants further enhancing the local surveillance of bacterial resistance and characterization of panresistance mechanism to inform the rational use of antimicrobial agents and containment of bacterial resistance.