2008年中国CHINET细菌耐药性监测

CHINET 2008 surveillance of bacterial resistance in China

目的了解国内主要地区医院临床分离菌对常用抗菌药物的耐药性。方法国内主要地区12所教学医院(10所综合性医院,2所儿童医院)临床分离菌采用K-B法按统一方案进行抗菌药物药敏试验。按CLSI2008版判断结果。结果2008年1—12月收集各医院临床分离株共36216株,其中革兰阳性菌占30.5%,革兰阴性菌占69.5%。各医院金葡菌(SA)和凝固酶阴性葡萄球菌(CNS)中甲氧西林耐药株平均为55.9%和75.9%。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中产ESBLs株平均为56.2%和43.6%。葡萄球菌属中甲氧西林耐药株对β内酰胺类抗生素和其他测试药的耐药率显著高于甲氧西林敏感株,但仍有72.4%和61.2%的金葡菌分别对复方磺胺甲口恶唑和磷霉素敏感;88.8%和60.1%的CNS分别对利福平、磷霉素敏感,未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试药物的耐药率低于屎肠球菌,但对氯霉素的耐药率相反。两者中均出现少数耐万古霉素和替考拉宁菌株,根据表型推测多数为VanA型耐药,无利奈唑胺耐药株。肺炎链球菌儿童分离株中青霉素不敏感株较成人株多。肠杆菌科细菌中产ESBLs株对抗菌药的耐药率均比非产ESBLs株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率<1%。铜绿假单胞菌对亚胺培南、美罗培南耐药率分别为30.5%、24.5%;不动杆菌属对两者的耐药率分别为48.1%、49.3%。米诺环素对嗜麦芽窄食单胞菌和伯克霍尔德菌有良好抗菌活性,敏感率均>90%。出现了较多泛耐药鲍曼不动杆菌和铜绿假单胞菌。结论细菌耐药性仍呈增长趋势,尤其万古霉素耐药肠球菌属和泛耐药鲍曼不动杆菌有显著增多,应引起注意,并及早采取防控措施。

Objective To investigate the resistance of clinical isolates from hospitals in several regions of China.Methods Ten general hospitals and two Children＇s hospitals were involved in this program. Bacterial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method. Results were analyzed according to CLSI 2008. Results A total of 36 216 clinical isolates were collected from January to December 2008,of which Gram negative organisms and Gram positive cocci accounted for 69.5% and 30.5% respectively. Methicillin resistant strains in S. aureus （MRSA） and coagulase negative Staphylococcus （MRCNS） accounted for an average of 55.9% and 75.9% respectively. The resistance rates of MR strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-sensitive strains. However about 72.4% and 61.2% of MRSA strains were still susceptible to sulfamethoxazole-trimethoprim and fosfomycin,while 88.8% and 60.1% of MRCNS strains were susceptible to rifampin and fosfomycin. No vancomycin,teicoplanin or linezolid resistant strains were found. In Enterococcus spp,the resistance rates of E. faecalis strains to most tested drugs were lower than those of E. faecium,however the resistance rates of the later strains to chloramphenicol was lower. There were some strains resistant to vancomycin and teicoplanin in both species; most of these resistant strains were VanA type based on their phenotype. No linezolid resistant strains were found. Penicillin non-susceptible strains in S. pneumoniae （PISP＋PRSP） isolated from Children＇s strains were much more than those in adult strains. Strains of Enterobacteriaceae were still highly susceptible to imipenem and meropenem. The overall resistance rate was 〈1%. Resistance rates of P. aeruginosa strains to imipenem and meropenem were 30.5% and 24.5%,respectively. The resistance rates of Acinetobacter spp to the two drugs were 48.1% and 49.3% respectively. Minocycline had good activity against S. maltophilia and Burkholderia spp. The isolates susceptible to minocycline were both higher than 90%. A number of pan-resistant strains in A. baumannii and P. aeruginosa were found.Conclusions Bacterial resistance is still increasing,especially VRE and pan-resistant A. baumannii strains. It is mandatory for hospitals to take effective control measures.