2006～2008年度MARS体液标本中细菌耐药监测分析

Analysis of annual drug resistance of bacteria isolated from body fluid specimens between 2006 and 2008 for Military Antimicrobial Resistance Surveillance

目的总结全军细菌耐药监测计划(MARS)西安地区临床分离病原菌的菌群分布及其耐药性。方法常规方法培养分离医院内感染病原菌,并应用全自动细菌鉴定分析仪或ATB系统鉴定到种,药敏试验方法按CLSI规定的标准进行。采用WHONET5.4软件进行数据统计分析。结果两年中体液标本中共分离病原菌493株,排名前5位的细菌分别为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌和屎肠球菌。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)检出率分别为40.74%、75.00%;大肠埃希菌、肺炎克雷伯菌ESBL的产生率分别为63.33%、65.91%;未发现对万古霉素、利奈唑胺耐药的葡萄球菌及肠球菌。鲍曼不动杆菌、铜绿假单胞菌对多粘菌素B全部敏感,对其他常用抗菌药物的耐药率在21.70%～92.00%之间。结论大肠埃希菌是体液标本中感染的主要病原菌;碳青酶烯类药物、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星对其保持良好的抗菌活性。鲍曼不动杆菌、屎肠球菌耐药现象严重,应引起临床重视。

Objective To summarize annual distribution of microbial population and drug resistance of bacteria isolated from body fluid specimens for Military Antimicrobial Resistance Surveillance（MARS） in Xihn region between 2006 and 2008. Methods Isolated bacteria were cultured by routine method and identified by automatic bacteria analysis system or ATB system. Drug susceptibility test was done according to CLSI standards. Data statistical analysis was conducted by means of WHONET5.4 software. Results In two years ,493 strains were isolated from body fluid specimens and the ranked order from first to fifth was Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter baumannii and Enterococcus faecius. The detection rate of methicillin resistant staphylococcus aureus （ MRSA ） was 40.74% while that of methicillin resistant coagulase negative staphylococcus （ MRCNS ） was 75.00%. The detection rate of Escherichia coli and Klebsiella pneumoniae producing extended - spectrum β - lactamases （ESBL）was 63.33% and 65.91% , respectively. No staphylococcus and enterococcus resistant to vancomycin or linezolid were found. Acinetobacter baumannii and Pseudomonas aeruginosa were all sensitive to Polymyxin B, and their drug resistant rate against other antimicrobial agents commonly used was between 21.70% and 92.00%. Conclusion Escherichia coli is a main pathogen in infected body fluid specimens. Carbapenems, piperacillin/tazobactam, cefoperazone/sulbactam and amikacin show high antibacterial activity against Escherichia coli. However, drug resistance of Acinetobacter baumannii and Enterococcus faecius is a serious problem which we should be paid close attention to.