2008年湖北省细菌耐药性监测

Surveillance of antimicrobial resistance in clinical isolates from Hubei province in 2008

目的调查2008年湖北省细菌耐药性监测网临床分离常见病原菌对常用抗菌药物的耐药情况。方法采用纸片扩散法进行抗菌药物敏感性试验,经WHONET5.4软件进行数据分析。结果24 272株临床分离病原菌中,革兰阳性菌7 936株,占32.7%,革兰阴性杆菌15 314株,占63.1%,真菌1 005株,占4.1%,厌氧菌18株。前6位病原菌依次为大肠埃希菌、凝固酶阴性葡萄球菌、铜绿假单胞菌、金葡菌、克雷伯菌属和不动杆菌属。MRSA、MRCNS检出率分别为56.1%和79.3%。检出万古霉素天然耐药肠球菌(即母鸡肠球菌和铅黄肠球菌)。肠杆菌科细菌对头孢哌酮-舒巴坦、哌拉西林-他唑巴坦的耐药率均低于20%,检出耐碳青霉烯类抗生素肺炎克雷伯菌3株。产ESBLs大肠埃希菌、克雷伯菌属和奇异变形杆菌检出率分别为65.1%、44.7%和25.3%。铜绿假单胞菌和不动杆菌属对头孢哌酮-舒巴坦耐药率均低于20%。泛耐药铜绿假单胞菌和鲍曼不动杆菌检出率分别为1.8%和8.0%。除磺胺甲口恶唑-甲氧苄啶、米诺环素和头孢哌酮-舒巴坦外,不动杆菌属对其他药物的耐药率均高于铜绿假单胞菌。嗜麦芽窄食单胞菌和伯克霍尔德菌属对磺胺甲口恶唑-甲氧苄啶和米诺环素的耐药率分别为19.3%和25.8,对米诺环素的耐药率分别为4.1%和54.5%。结论临床常见病原菌中革兰阴性杆菌约占2/3,碳青霉烯类抗生素对肠杆菌科细菌仍保持最高抗菌活性。临床细菌对多数常用抗菌药物耐药率呈上升趋势,尤以不发酵糖菌上升明显。

Objective To investigate the resistance of clinical isolates from Hubei province to commonly used antimicrobial agents during 2008.Methods Disk diffusion method was used to determine the antimicrobial susceptibility.Data were analyzed by WHONET 5.4 software.Results A total of 24 272 clinical isolates were collected,including gram-positive cocci（32.7%） and gram-negative bacilli（63.1%）.The top six pathogens were E.coli,coagulase-negative Staphylococcus,P.aeruginosa,S.aureus,Klebsiella spp.and Acinetobacter spp.The prevalence of MRSA and MRCNS were 56.1% and 79.3%,respectively.Several strains of Enterococcus with intrinsic resistance to vancomycin were found.The resistant rates of Enterobacteriaceae to cefoperazone-sulbactam and piperacillin-tazobactam were lower than 20%.Three strains of K.pneumoniae were resistant to carbapenems.ESBLs-producing strains accounted for 65.1%,44.7% and 25.3% in E.coli,Klebsiella spp.and P.mirabilis,respectively.Not more than 20% of P.aeruginosa and Acinetobacter spp.were resistant to cefoperazone-sulbactam.The prevalence of pan-resistant P.aeruginosa and A.baumannii was 1.8% and 8.0%,respectively.The resistance of Acinetobacter spp.to most antimicrobial agents other than SMZ-TMP,minocycline and cefoperazone-sulbactam was higher than that of P.aeruginosa.The resistance rates of S.maltophilia and Burkholderia spp.were 19.3%,25.8% to SMZ-TMP,4.1% and 54.5% to minocycline.Conclusions Two thirds of these clinical isolates are gram-negative bacilli,for which carbapenems are highly active.The resistance to most antimicrobial agents is increasing in the clinical isolates,especially nonfermentative bacteria,from Hubei province.