临床分离病原菌的耐药性变迁

Changing antibiotic resistance pattern of clinical isolates in a teaching hospital

目的分析武汉同济医院近11年临床分离病原菌分布及对抗菌药物耐药性变迁情况。方法分析该院1999年1月—2009年12月细菌耐药监测资料,根据CLSI 2009年判读标准判定耐药性。结果 11年内共分离31 861株细菌,其中革兰阴性杆菌占65.2%,革兰阳性球菌占34.1%。大肠埃希菌所占比率连续11年最高。2003年之后,不动杆菌属比率明显增加,2009年已占第2位。多重耐药细菌的比率逐年增加。青霉素不敏感肺炎链球菌(PNSSP)的比率由4.9%增长为30.0%,耐甲氧西林金葡菌(MRSA)的比率在50.6%～64.4%。11年共分离到对万古霉素和(或)替考拉宁耐药的肠球菌24株。肠杆菌科细菌中产ESBLs大肠埃希菌由29.6%增长为78.3%,克雷伯菌属由35.9%增长至51.1%,首次分离到碳青霉烯类抗生素不敏感肠杆菌科细菌。耐亚胺培南、美罗培南鲍曼不动杆菌增长迅速(14.0%～72.7%),耐亚胺培南、美罗培南铜绿假单胞菌占20.9%～34.1%。结论临床分离菌的菌种不断发生变化,鲍曼不动杆菌不断增多。细菌耐药性日益严重,多重耐药细菌逐年增加。

Objective To investigate the changing pattern of antibiotic resistance of clinical isolates in our hospital during recent 11years. Methods The antibiotic resistance of clinical isolates from 1999 and 2009 were analyzed retrospectively with WHONET 5.4 software. Drug resistance was interpreted according to the criteria published by Clinical and Laboratory Standards In stitute （CLSI） 2009 M100- 19. Results A total of 31 861 strains were included. Gram-positive cocci and Gram negative bacilli accounted for 34.1% and 65.2 %, respectively. Escherichia coli was always the most frequently isolated pathogen during the 11 years. Since 2003, Acinetobacter isolates increased obviously and has n, oved to the second position on the list since 2008, only next to E. coli. Muhidrug resistant strains have been increasing year by year. The prevalence of MRSA was 63.8% （350/ 549） in 2009. Strains resistant to vancomycin and/or teicoplanin were found in Enterococcus （24）. The prevalence of penicillin non-susceptible S. pneumoniae （PNSSP） has increased from 4.9% to 30.0%. The prevalence of ESBLs-producing E. coli has increased from 29. 6% to 78.3%, while Klebsiella spp. from 35. 9% to 51. 1 %. The prevalence of carbapenems resistant Acinetobucter spp. increased quickly （14.0%-72.7%）. Carbapenems-resistant P. aeruginosa fluctuated between 20.9%-34.1 %. Sixty-seven Enterobacte riaceae strains were found non susceptible to carbapenems since 1999. Conclusions The antibiotic resistance pattern of pathogens from nosoeomial infections has been changing all the time. Acinetobacter baumanii has become more and more important in nosocomial infec tions. Bacterial resistance is becoming more serious. Multidrug resistant strains are increasing year by year. It is very important to select appropriate antibiotic therapy according to the results of susceptibility tests.