铜陵市部分医院细菌耐药性监测与分析

Surveillance of bacterial resistance in Tongling area

目的了解安徽省铜陵市临床分离菌株耐药状况。方法2007年1～12月铜陵市临床分离菌株用Kirby-Bauer法进行药敏试验。结果1375株细菌中,革兰阳性菌399株,占29.0%;革兰阴性菌976株,占71.0%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌(CNS)的18.4%和70.0%;MRSA和MRCNS对庆大霉素、环丙沙星、克林霉素和红霉素等均高度耐药,对利福平、氯霉素和呋喃妥因的耐药率均较低,未见耐万古霉素葡萄球菌。粪肠球菌对青霉素、氨苄西林、呋喃妥因、磷霉素和氯霉素的耐药率较低,未见耐万古霉素和替考拉宁粪肠球菌;屎肠球菌对磷霉素和氯霉素耐药率较低,发现2株耐万古霉素屎肠球菌。大肠埃希菌和克雷伯菌属中产超广谱β-内酰胺酶(ESBLs)株分别占49.3%和35.9%,产ESBLs株除对亚胺培南和美罗培南敏感外,对其他20种抗生素的耐药率均较不产ESBLs株高。非发酵菌对碳青霉烯类、头孢哌酮/舒巴坦、哌拉西林/三唑巴坦、头孢他啶、头孢吡肟、阿米卡星、环丙沙星等耐药率较低。结论革兰阳性菌对糖肽类抗生素耐药率低;革兰阴性菌对碳青霉烯类、头孢哌酮/舒巴坦、哌拉西林/三唑巴坦等耐药率低。加强细菌耐药性监测对合理使用抗生素、减少耐药菌株的产生和流行有重要临床指导价值。

Objective To investigate the bacterial resistance of clinical isolates collected in Tongling area. Methods The clinical isolates were collected in Tongling area from Jananuary to December in 2007. Antimicrobial susceptibility test were conducted by Kirby-Bauer method. Results Of 1 375 clinical isolates, 399 strains （29.0%） were gram positive bacteria, and 976 strains （71.0%） were gram negative bacteria. Methicillin resistant staphylococcus aureus （MRSA） accounted for 18.4% of staphylococcus aureus, while methieillin resistant coagulase negative staphylococci （MRCNS） were 70. 0% of coagulase negative staphylococci （CNS） respectively. MRSA and MRCNS were highly resistant to gentamicin, ciprofloxaein, clindamycin and erythromycin; but displayed lower resistance to rifampicin, chloramphenieol and nitrofurantion. No vaneomyein-resistant staphylococcus strain was found. The resistance rates of Enterococcus faccalis were relatively low to penicillin, ampicillin, nitrofurantion, fosfomycin and chloramphenicol. No vancomycin or teicoplanin-resistant enterococcus faecalis was isolated. The resistance rates of E. faecium were lower to fosfomycin and chloramphenicol. Two strains of vancomycin-resistant E. faecium were identified. About of 49.3 % of E. coli and 35.9 of Klebsiella isolates produced extended-spectrum β-lactamases （ESBLs）. The resistance rates of ESBLs-producing strains to 20 antimicrobial agents were much higher than those of ESBLs nonproducing ones. No imipenem or meropenem-resistant isolate was found. The resistance rate of non-fermenters was lower to imipenem, meropenem, cefoperazone-sulbactam, piperacillin-tazobactam, ceftazidime, cefepime, amikacin or ciprofloxacin. Conclusion The resistance rate of gram positive bacteria is lower to glycopeptides. The resistance rate of gram negative bacilli is lower to imipenem, meropenem, cefoperazone-sulbactam, and piperacillin-tazobactam. Surveillance of bacterial resistance is of great im- portance for rational use of antibiotics and reducing the emergence of resistance.