Mohnarin 2008年度报告:腹腔感染病原菌分布及耐药监测

2008 Mohnarin report: Bacterial distribution and resistance in intra-abdominal infections

目的了解2008年度我国腹腔感染细菌分布及耐药状况。方法采用纸片法、MIC法或E-test法,使用WHONET5.4软件进行分析,对卫生部全国细菌耐药性监测网(Mohnarin)所属89家三级甲等医院2008年1月1日—2008年12月31日从腹腔感染标本中分离的菌株进行分析。结果共分离菌株1405株,其中革兰阳性菌582株(41.4%),革兰阴性菌823(58.6%)株。分离率最高的前5位病原菌为大肠埃希菌(23%)、屎肠球菌(7.6%)、铜绿假单胞菌(7.3%)、金黄色葡萄球菌(7.1%)和表皮葡萄球菌(6.8%)。大肠埃希菌和肺炎克雷伯菌对氟喹诺酮类的耐药率分别为77%与46.7%,ESBLs阳性检出率分别为47.1%和35.5%。发现1株万古霉素耐药粪肠球菌(VRE),粪肠球菌对替考拉宁耐药率为1.8%,屎肠球菌对万古霉素中介率为1.4%。耐甲氧西林金黄色葡萄球菌(MRSA)与凝固酶阴性葡萄球菌(MRCNS)的检出率分别为80.0%与74.3%,未检测到万古霉素耐药株,金黄色葡萄球菌和表皮葡萄球菌对替考拉宁的中介率分别为有1.8%与2.3%。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为28.8%和52.6%。结论我国腹腔感染主要致病菌以大肠埃希菌为代表的革兰阴性杆菌为主,肠球菌等革兰阳性菌所占比例有所增多;细菌耐药性仍呈上升趋势,应采取有效措施,控制耐药菌增长与传播。

Objective To determine the bacterial distribution and resistant to antibiotic in intra-abdominal infections in China. Methods Disc diffusion test, MIC test and E-test were used to study the antimicrobial resistance. WHONET5.4 was applied for analysis the antibacterial sensitive data from 89 tertiary hospitals of Mohnarin at different area in China from Jan 1, 2008 to Dec 31, 2008. Results A total of 1,405 pathogenic strains were collected, with Gram-positive cocci 582 strains（41.4%） and Gram-negative bacilli 823（58.6%）. The top five pathogens were E. coli（23%）, Enterococcus faecium（7.6%）, P. aeruginosa（7.3%）, S. aureus（7.1%） and S. epidermidis（6.8%）. The resistance rates orE. coli and K. pneumonia to fluoroquinolones were 77% and 46.7%. 47.1% ofE. coli and 35.5% K. pneumonia were ESBLs producers. One E. faecalis strain was resistant to vancomycin, 1.8% was resistant to teicoplanin. 1.4% Enterococcus faecium strains were intermediate to vancomycin. Methicillin resistant strains in S. aureus （MRSA） and MRCNS accounted for an average of 80.0 % and 74.3 %, respectively. No vancomycin resistant isolates were found in Staphylococcus, but the intermediate rates of S. aureus and S. epdermidis to teicoplanin were 1.8% and 2.3%, respectively. The resistance rates of P. aeruginosa and A. baumannii to imipenem were 28.8% and 52.6%, respectively. Conclusion Gram-negative bacilli such as E. coli was predominant organism in intra-abdominal infections in China, but Gram positive bacteria such as Entercoccus increased obviously in recent years. The bacterial resistance was still on the rise, more effective measures should be taken to control the dissemination and growth of resistant strains.