全国10所医院院内与社区感染常见病原菌耐药性分析

Antimicrobial Resistance Surveillance on Hospital-and Community-acquired Pathogens in 10 Teaching Hospitals in China

目的监测我国不同地区10所教学医院分离的社区和院内常见病原菌的耐药性。方法按设计方案收集10所教学医院中分离出的肺炎链球菌、甲氧西林敏感金黄色葡萄球菌（MSSA）、大肠埃希菌和肺炎克雷伯菌；菌株经中心实验室复核后，采用Etest法测定抗菌药物对肺炎链球菌的最低抑菌浓度（MIC），用琼脂稀释法测定抗菌药物对金黄色葡萄球菌、大肠埃希菌和肺炎克雷伯菌的MIC，数据输入WHONET5．4软件进行耐药性分析。结果在收集的353株肺炎链球菌中，青霉素敏感肺炎链球菌（PSSP）占74．2％，青霉素中介肺炎链球菌（PISP）占9．6％，耐青霉素肺炎链球菌（PRSP）占16．2％；不同医院分离的肺炎链球菌对青霉素的敏感性也不尽相同，在测试的β-内酰胺类药物中，头孢呋辛的敏感性较低，为0～76．7％，头孢曲松和阿莫西林／克拉维酸的敏感性较高，PSSP组中分别为98．1％和98．9％，PISP组中分别为61．8％和64．7％，PRSP组中分别为15．8％和10．5％；267株大肠埃希菌产超广谱p内酰胺酶（ESBLs）的比率为56．2％，206株肺炎克雷伯菌为42．7％，对于产ESBLs菌株，头孢噻肟和头孢曲松的敏感性均较低，而头孢他啶的敏感性在测试的伊内酰胺类药物中相对较高；177株MSSA的β-内酰胺酶产酶率为73．4％，测试的β-内酰胺类抗菌药物对MSSA表现出很好的抗菌活性，敏感率98．9％～100．0％，环丙沙星和左氧氟沙星的敏感率分别为80．8％和88．1％。结论对于肺炎链球菌，氟喹诺酮类药物保持了较高的体外抗菌活性，头孢曲松和阿莫西林／克拉维酸在β-内酰胺类药物中表现较好；对于MSSA以及非产ESBLs的大肠埃希菌和肺炎克雷伯菌，β-内酰胺类药物均表现出较高的抗菌活性，对于产ESBLs的大肠埃希菌和肺炎克雷伯菌，头孢噻肟和头孢曲松的敏感性均较低，而头孢他啶、头孢吡肟和头孢哌酮／舒巴坦的敏感性相对较高。

OBJECTIVE To investigate the antimicrobial resistance of hospital-and community-acquired pathogens collected from 10 teaching hospitals located at different areas in China in 2006. METHODS According to the study protocol, the strains of Streptococcus pneumoniae, meticillin-susceptible Staphylococcus aureus （MSSA）, Esche- richia coli and Klebsiella pneumoniae were collected and sent to the central lab for reidentification and susceptibility testing. The minimal inhibitory concentrations （MICs） of antimierobial agents against Str. pneu- moniae were determined by Etest method and MICs of antimicrobial agents against S. aureus, E. coli and K. pneurnoniae strains were determined by agar dilution method. WHONET5.4 software was used to analyze the data. RESULTS Among 353 Str. pneumoniae strains, 74. 2% were penicillin-susceptible （PSSP）, 9.6% were penicillin-intermediate （PISP） and 16.2% were penicillin-resistant （PRSP）. Strains from different hospitals showed different sensitivity to penicillin. Among β-lactam antibiotics, cefuroxime showed the lowest susceptibility rate of 0 % （for PRSP） to 76.7%（for PSSP）. The susceptibility rate to ceftriaxone and amoxicillin-clavulanic acid was 98.1% and 98. 9% in PSSP group, 61.8% and 64. 7% in PISP group, and 15. 8% and 10. 5% in PRSP group. The ESBLs rate was 56. 2% among 267 Escherichia strains and 42.7% among 206 K. pneumoniae strains. For ESBLs-producing strains, the susceptibility rates to cefotaxime and ceftriaxone were low and the rate to ceftazidime was relatively high among β-lactam antibiotics. 73. 4% MSSA strains produced β-lactamase. β- Lactam antibiotics tested showed high susceptibility against MSSA strains. The susceptibility rate was 98.9-100%. The susceptibility rate to ciprofloxacin and levofloxacin was 80.8% and 88.1%, separately. CONCLUSIONS Fluoroquinolones show high susceptibility against Str. pneumoniae. Ceftriaxone and amoxicillin- clavulanic acid have relatively high susceptibility among β-lactams. For MSSA and non-ESBLs-producing E. coli and K. pneumoniae strains, β-lactams show high susceptibility. For ESBLs-producing E. coli and K. pneumoniae strains, the susceptibility rates to cefotaxime and ceftriaxone are low and that to ceftazidime, cefepime and cefoperazone-sulbactam are relatively high.