2008年上海地区细菌耐药性监测

Surveillance of bacterial resistance from hospitals in Shanghai during 2008

目的了解上海地区2008年14所医院临床分离株的耐药情况。方法采用纸片扩散法(K-B法)对临床分离菌株进行药敏试验。以CLSI2008年版为判断标准。结果共收集临床分离菌35 797株,其中革兰阳性菌占32.3%,革兰阴性菌占67.7%。4 486株金葡菌中MRSA检出率为62.3%,2 025株凝固酶阴性葡萄球菌(CNS)中MRCNS检出率为77.0%。未发现万古霉素、替考拉宁和利奈唑胺耐药株。616株肺炎链球菌中7株为脑膜炎肺炎链球菌,609株为非脑膜炎肺炎链球菌。568株儿童患者非脑膜炎肺炎链球菌中青霉素敏感菌株(PSSP)占78.5%,青霉素中介株(PISP)和青霉素耐药株(PRSP)检出率分别为11.3%和10.2%。41株成人患者非脑膜炎肺炎链球菌均为PSSP,未发现青霉素不敏感株。检出3株万古霉素耐药屎肠球菌。2株为Van A型,1株为Van B型。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌+产酸克雷伯菌)和奇异变形杆菌中产ESBLs检出率分别为58.9%、49.6%和15.8%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为22.8%和19.2%。不动杆菌属对亚胺培南和美罗培南的耐药率分别为27.4%和28.3%。出现少数铜绿假单胞菌、鲍曼不动杆菌、弗劳地柠檬酸杆菌和肺炎克雷伯菌对现用抗菌药(除多黏菌素外)均耐药的泛耐药株。结论细菌耐药性仍呈上升趋势,出现少数泛耐药革兰阴性杆菌,特别是泛耐药鲍曼不动杆菌较往年有较显著的增加,应引起重视。

Objective To investigate the bacterial resistance profile of clinical isolates in Shanghai hospitals from January to December in 2008. Methods The antimicrobial susceptibility of 35 797 clinical isolates was tested according to an agreed protocol using Kirby-Bauer （KB） method. Results Resuits were analyzed according to CLSI criteria 2008. Of the 35 797 clinical isolates, gram negative bacilli and gram positive cocci accounted for 67.7% and 32.3% respectively. The preva- lence of MRSA in S. aureus and MRCNS in coagulase negative Staphylococcus was 62. 3% and 77. 0%, respectively. No staphylococcal strain was found resistant to vancomycin, teicoplanin or linezolid. Of the 616 strains of S. pneumoniae isolates, 7 were from meningitis and 609 were nonmeningitis isolates. The prevalence of penicillin-susceptible S. pneumoniae （PSSP） was 78.5 % in the 568 nonmeningitis strains from children. Penicillin-nonsusceptible S. pneumoniae （PISP ＋ PRSP） strains accounted for 21.6% （PISP 11.3% and PRSP 10. 2%）. The 41 nonmeningitis strains from adults were all PSSP. Three vancomycin-resistant Enterococcus （VRE） strains were found in E. faecium, including 2 strains of vanA type, 1 vanB type. The prevalence of ESBLs-producing strains was 58. 9%, 49.6% and 15.8% in E. coli, Klebsiella spp （K. pneumoniae ＋ K. oxytoca） and P. mirabilis, respectively. About 22.8% and 19.2% of P. aeruginosa isolates were resistant to imipenem and meropenem respectively. About 27.4% and 28.3 % of Acinetobacter isolates were resistant to imipenem and meropenem respectively. Some pan-resistant isolates were identified in P. aeruginosa, A. baumannii, C. freundii and K. pneumoniae. Conclusions Bacterial resistance is still on the rise. A few strains of pan-resistant gram-negative bacilli are identified. It is important to note that the prevalence of pan-resistant A. baumannii in 2008 is higher than that in previous years.