Mohnarin 2008年度报告:中南地区细菌耐药监测

2008 Mohnarin report:Bacterial distribution and resistance in central-southern China

目的分析中南地区2008年临床分离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。结果中南地区11所三级甲等医院共分离32891株细菌,革兰阴性菌占70.3%,革兰阳性菌占29.6%。前10位病原菌依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、阴沟肠杆菌、屎肠球菌、溶血葡萄球菌。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(MRSCN)的检出率分别为62.1%和83.6%。耐万古霉素和/或替考拉宁的肠球菌17株,分离率0.7%。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形菌中产ESBLs株分离率分别为59.3%、37.5%和6.3%,儿童组(≤14岁)大肠埃希菌和克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)产ESBLs株分离率为70.9%和64.9%,成人组(>14岁)为58.4%和35.0%。碳青霉烯类耐药肠杆菌科细菌检出率为0.7%。不动杆菌属细菌对亚胺培南和美罗培南的敏感率分别为53.8%和55.7%,铜绿假单胞菌敏感率分别为71.8%和76%。嗜麦芽寡养单胞菌对左氧氟沙星和TMP/SMZ的敏感率为83.7%和81.9%。流感嗜血菌对TMP/SMZ和氨苄西林的敏感率较低,分别为40.8%和58.7%。儿童组产β-内酰胺酶流感嗜血菌分离率48.6%,明显高于成人组分离率22.0%(P<0.05)。罕见β-内酰胺酶阴性而氨苄西林耐药的流感嗜血菌(BLNAR)15株,占4.1%。结论临床常见病原菌仍以革兰阴性杆菌为主,细菌耐药性呈上升趋势。儿童组产ESBLs菌株较成人组高,出现少数耐万古霉素肠球菌、碳青霉烯类耐药肠杆菌科细菌及多重耐药革兰阴性杆菌,应引起重视。

Objective To investigate the antibiotic resistance of clinical isolates from central-southern region of China in 2008. Methods Antimicrobial susceptibility was tested by Kirby-Bauer method. Results A total of 32891 strains were isolated by 11 hospitals in central-southern China during 2008, with Gram-negative bacilli 70.3% and Gram-positive cocci 29.6%. The top ten pathogens were E. coli, P. aeruginosa, K. pneumonia, A. baumannii, S. aureus, S. epidermidis, E. faecal＆, E. cloacae, E. faecium and S. hominis. The prevalence of MRSA and MRSCN were 62.1% and 83.6% respectively, 17 strains resistant to vancomycin and/or teicoplanin were found in Enterococcus spp., and the isolating rate was 0.7%. The isolating rates of ESBLs-producing E. coil Klebsiella spp. （K. pneumonia and K. oxytoca） and P. mirabilis were 59.3%, 37.5% and 6.3%, respectively. ESBLs-producing E. coli and Klebsiella spp. from groups of children （≤ 14 years old） accounted for 70.9% and 64.9%, with that from groups of adults （〉14 years old） accounted for 58.4% and 35.0%. The isolating rate of carbapenems resistant Enterobacteriaceae was 0.7%.The sensitivity rates ofAcinetobacter spp. to imipenem and meropenem were 53.8% and 55.7%, while P. aeruginosa were 71.8% and 76%, respectively. The sensitivity rates of X. maltaphilia to levofloxacin and TMP/SMZ were 83.7% and 81.9%. H. influenzae were low sensitive to TMP/SMZ, the sensitivity rate was 40.8%, and only 58.7% of strains were sensitive to ampicillin. The isolating rate of 13-1actamase producing H. influenzae from groups of children was 48.6%, significantly higher than that from groups of adults, which was 22.0% （P〈0.05）. 15 strains of beta-lactamasenonproducing ampicillin-resistant H. influenzae （BLNAR） were found, accounted for 4. 1%. Conclusion Most clinical isolates were remainly Gram-negative bacilli, and bacterial resistance rate is on the rise. The prevalence of ESBLs-producing strains from children was higher than that from groups of adults. A few strains of vancomycinresistant enterococci, carbapenems resistant Enterobacteriaceae and multi-drug resistant Gram-negative bacilli were identified, which should take our attention.