Mohnarin 2008年胆汁培养病原菌构成及耐药性分析

Mohnarin of 2008:Components and Drug Resistance of Pathogens from Cultured Bile

目的了解胆道感染病原菌分布和耐药情况,供临床抗菌药物选择参考。方法按照卫生部全国细菌耐药监测网(Mohnarin)统一方案,对89所医院2008年1月1日-12月31日,胆汁培养细菌进行药敏测定,利用WHONET5.4软件进行数据分析。结果共分离1401株病原菌,其中革兰阴性菌941株,占67.2%,前3位依次为大肠埃希菌(27.4%)、铜绿假单胞菌(9.4%),肺炎克雷伯菌(8.3%);革兰阳性菌460株,占32.8%,前3位依次为粪肠球菌(11.7%)、屎肠球菌(9.8%)、表皮葡萄球菌(2.6%);大肠埃希菌和肺炎克雷伯菌对三、四代头孢菌素耐药率为56.6%～56.9%、31.1%～33.6%,对左氧氟沙星耐药率分别为64.6%和29.2%,与同期整体细菌耐药监测结果相似;铜绿假单胞菌对亚胺培南、头孢哌酮/舒巴坦耐药率分别为28.7%、19.8%;鲍氏不动杆菌对亚胺培南耐药率为34.4%,高于铜绿假单胞菌耐药率,耐甲氧西林金黄色葡萄球菌比率为61.5%,耐糖肽类肠球菌分离率较低,与上年度结果比较,肠杆菌科细菌对头孢他啶、头孢吡肟耐药率上升明显。结论胆道感染病原菌分布仍然以革兰阴性菌为主,常见病原菌对多种抗菌药物耐药明显,肠杆菌科细菌对头孢他啶、头孢吡肟耐药率明显上升,鲍氏不动杆菌对碳青酶烯类耐药明显。

OBJECTIVE To study the bacterial distribution and drug resistance of biliary tract infections in China,to provide references for antibiotics application.METHODS Software WHONET 5.4 was applied for the analysis of the bacterial drug sensitivity data from 89 tertiary care Mohnarin member hospitals Jan 1,2008 to Dec 31,2008,according to the unified pretocoe of Mohnarin.RESULTS A total of 1401 bacterial strains were isolated during the survey period,which included 941 Gram-negative strains （67.2%）,of which the top three were Escherichia coli （27.4%）,Pseudomonas aeruginosa（9.4%） and Klebsiella pneumoniae（ 8.3%）;460 Gram-positive strains（32.8%）,the top three were Enterococcus faecalis（11.7%）,E.faecium（ 9.8%） and Staphylococcus epidermidis（2.6%）.The drug susceptibility results showed that the resistant rates of E.coli and K.pneumoniae to the third and fourth generation cephalosporins were 56.6%-56.9% and 31.1%-33.6%;and the drug resistance rates to levofloxacin were 64.6% and 29.2%,respectively,which were comparable with the results of overall surveillance.28.7% and 19.8% of P.aeruginosa were resistant to imipenem and cefoperazone/sulbactam,while 34.4% of Acinetobacter baumannii were resistant to imipenem.Methicillin-resistant S.aureus （MRSA） from bile samples was 61.5% and vancomycin-resistant Enterococcus were rare.Comparing with the results of 2007,the resistant rates of E.coli against third and fourth generation cephalosporin increased obviously.CONCLUSION Gram-negative bacilli remain the predominant pathogens in biliary tract infections,the common pathogens are resistant to many antibiotics.The drug resistance rates of E.coli to ceftazidime and cefepime increase sharply,and the drug resistance of A.baumannii to carbapenem is obvious.