浙江大学医学院附属第一医院2009年细菌耐药性监测

Surveillance of antibiotic resistance in clinical isolates from First Affiliated Hospital of Zhejiang University Medical College in 2009

目的分析浙江大学医学院附属第一医院2009年临床分离细菌对抗菌药物的耐药性。方法采用Kirby-Bauer（K-B）法对5 961株临床分离菌进行药敏试验,结果按CLSI2009年版标准判断及采用WHONET5.4软件进行统计分析。结果全年共分离5 961株细菌,其中革兰阴性菌4 185株（70.2%）,革兰阳性菌1 776株（29.8%）。MRSA和MRCNS检出率分别为49.4%（134/271）和69.7%（568/815）,未检测到万古霉素、替考拉宁、利奈唑胺耐药株,检出万古霉素耐药粪肠球菌1株和屎肠球菌17株。肺炎链球菌对青霉素敏感率为97.4%,未检出耐药株。β溶血链球菌对万古霉素、青霉素、头孢曲松、头孢噻肟和头孢呋辛均高度敏感。大肠埃希菌、肺炎克雷伯菌ESBLs的检出率分别为56.8%（536/944）、39.6%（226/570）,肠杆菌科细菌对亚胺培南和美罗培南仍保持较高的敏感性（〉96%）。鲍曼不动杆菌对众多抗菌药物的耐药率很高,仅对头孢哌酮-舒巴坦耐药率较低为43.8%,对美罗培南、亚胺培南耐药率〉70%。铜绿假单胞菌对阿米卡星耐药率最低为11.5%,其次为头孢吡肟、庆大霉素、环丙沙星、头孢哌酮-舒巴坦、头孢他啶和头孢哌酮（16.2%~26.5%）,对美罗培南、亚胺培南耐药率分别为34.4%、39%。米诺环素对嗜麦芽窄食单胞菌、洋葱伯克霍尔德菌有较好的抗菌活性（耐药率〈10%）。结论 2009年该院分离的细菌以革兰阴性杆菌为主,细菌多重耐药性严重,万古霉素耐药肠球菌和碳青霉烯类抗生素耐药肺炎克雷伯菌有增多趋势,应引起重视。

Objective To investigate the resistance of clinical isolates from our hospital in 2009.MethodsAntimicrobial susceptibility testing was carried out by means of Kirby-Bauer（KB） method.The data were analyzed by WHONET 5.4 software.ResultsOf the 5 961 clinical isolates,gram-negative bacilli and gram-positive cocci accounted for 70.2%（4 185/5 961） and 29.8%（1 776/5 961）,respectively.The prevalence of methicillin-resistant isolates was 49.4%（134/271） in Staphylococcus aureus（MRSA） and 69.7%（568/815） in coagulase negative Staphylococcus（MRCNS）.No vancomycin or teicoplanin resistant isolate was found in Staphylococcus.One Enterococcus faecalis and 17 Enterococcus faecium isolates were found resistant to vancomycin.Majority strains（97.4%） of Streptococcus pneumoniae were susceptible to penicillin.No resistant isolate was found.Beta-hemolytic Streptococcus was highly sensitive to vancomycin,penicillin,cefotaxime,cefuroxime,and ceftriaxone.The prevalence of extended-spectrum β-lactamases（ESBLs） was 56.8%（536/944） in Escherichia coli,and 39.6%（226/570） in Klebsiella pneumoniae.Imipenem and meropenem were the most potent antimicrobial agents against Enterobacteriaceae（96%）.Acinetobacter baumannii was highly resistant.Cefoperazone-sulbactam was relatively active against A.baumannii isolates（43.8% resistant）.More than 70% of these isolates were resistant to imipenem and meropenem.The most active agent against P.aeruginosa was amikacin（11.5% resistant）,followed by cefepime,gentamicin,ciprofloxacin,cefoperazone-sulbactam,ceftazidime,cefoperazone（16.2%-26.5% resistant）.About 34.4% and 39% of these P.aeruginosa isolates were resistant to meropenem and imipenem.Minocycline was the most active agent against Stenotrophomonas maltophilia and Burkholderia cepacia（10% resistant）.ConclusionsMost clinical isolates collected in 2009 were gram-negative bacilli.The antimicrobial resistance of common pathogenic bacteria was serious,especially the increasing prevalence of vancomycin-resistant Enterococcus and carbapenems-resistant Klebsiella pneumoniae.