卫生部全国细菌耐药监测网(Mohnarin)2007-2008年报告

Antimicrobial susceptibility surveillance in China:a Mohnarin program 2007-2008 report

目的监测我国主要城市三级甲等医院住院患者的细菌耐药状况。方法定点收集来自全国20家医院临床分离细菌,由中心实验室统一用平皿二倍稀释法,测定抗菌药物MIC值。对2007年1月至2008年3月来自全国19座城市20家医院的5204株临床分离致病菌,进行了MIC测定。结果革兰阳性菌1310株,占25.2%;革兰阴性菌3894株,占74.8%。MIC结果显示,对甲氧西林耐药葡萄球菌(MRSA)和对甲氧西林耐药表皮葡萄球菌(MRSE)检出率分别为73.6%和79.5%;未发现对万古霉素中介或耐药的葡萄球菌;凝固酶阴性葡萄球菌对替考拉宁有2.4%的中介率和1.2%的耐药率。粪肠球菌对青霉素的耐药率为23.7%;屎肠球菌则高达88.7%。在344株肠球菌中,发现2株对糖肽类耐药的VanA型屎肠球菌;5株对万古霉素中介的其他肠球菌。按口服青霉素V标准判断,对青霉素耐药肺炎链球菌(PRSP)和对青霉素中介肺炎链球菌(PISP)的检出率分别为17.3%和46.0%;非脑膜炎、非肠道系统给药的青霉素耐药率为0,中介率为0.8%。肠杆菌科细菌对碳青霉烯类抗生素,仍保持很高的敏感性,敏感率大于99%;此外,拉氧头孢、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦也具有很好抗菌活性,耐药率均在10%以下。非发酵革兰阴性菌中,铜绿假单胞菌和鲍曼不动杆菌,对亚安培南的耐药率分别为29.3%和29.2%,较2004-2005年的监测结果有明显增加,但仍属于对非发酵菌抗菌活性较好的药物。此外,酶抑制剂复方制剂、氟喹诺酮类药物及米诺环素等也有较强抗菌作用。比较不同病房来源菌株耐药率显示,ICU菌株耐药率高于NICU,但两者之间的差距在缩小。结论 MRSA检出率以及金黄色葡萄球菌、大肠埃希菌和鲍曼不动杆菌耐药率增高,较以往的监测结果明显上升。大环内酯类、喹诺酮及氨基糖苷类药物抗菌作用明显低于欧美及日本等监测报道;大肠埃希菌对多种抗菌药物的耐药率,明显高于国外报道。

Objective To investigate the antibacterial resistance in nationwide,to understand the trend of antimicrobial resistance and to provide scientific data for government policy-making and clinical antibiotic applications.Method All the clinical isolates were collected from hospitals and the susceptibility tests were performed using agar dilution method by central laboratory recommended by CLSI.The susceptibilities of isolates to antimicrobial agents were determined by using CLSI（2009） guideline.A total of 5204 pathogenic isolates from 20 tertiary hospitals in 19 cities nationwide over the period from January 2007 to March 2008 were studied.Results Of all these isolates,1310 were gram-positive,accounting for 25.2% of the total and 3894 were gram-negative,constituting 74.8%.Based on the MIC results,the prevalence of methicillin resistance Staphylococcus aureus（MRSA） and methicillin resistance Staphylocoeei epidermides（MRSE） reached 73.6% and 79.5%,respectively.Staphylococci showing intermediate or full resistance to vancomycin were not observed.CoNS（coagulase negative Staphylococci） showed intermediate and full resistance to teicoplanin at 2.4% and 1.2%,respectively.Antibiotic resistance rate of E.faecalis to ampicillin was 12.5%,while the resistance rate of E.faecium to ampicillin reached up to 85.4%.The prevalence of penicillin resistance Streptococcus pheumoniae and penicillin intermediate Streptococcus pheumoniae were 17.3% and 46.0% respectively based on previous CLSI standards（before 2008）;while the resistance rate and intermediate rate（for cases of non-meningitis and parenteral administration） were 0 and 0.8%,according to the CLSI（2008 and 2009）.A vast majority of Enterobacteriaceae maintained high susceptibility to carbapenems,with susceptibility rate over 99%.In addition,moxalactam,piperacillin/tazobactam and cefoperazone/sulbactam displayed desirable antibacterial activity against Enterbacteriaceae,and resistance rates to these drugs were all below 10%.For non-fermenting gram-negative isolates,resistance rate of P.aeruginosa and A.baumannii to imipenem were 29.3% and 29.2% respectively,considerably higher than those during the period 2004-2005.Nevertheless,imipenem was still considered sensitive to non-fermenters.Furthermore,β-lactermase-inhibitor compounds,fluoroquinolones,and minocycline demonstrated good antibacterial activity against non-fermenters.Comparing resistance rates of isolates from different sources,resistance rates were higher in ICU than NICU,though the gaps were narrowing.Conclusion Compared with mohnarin 2004-2005 year surveillance results,considerable rise in MRSA prevalence and significant increase in detection rates of S.aureus,E.coli and A.baumannii were demonstrated.Compared to surveillance results from foreign countries,antibacterial activities of macrolides to gram-positive cocci,fluoroquinolones and aminoglycosides to Enterobacteriaceae were significantly lower than counterparts reported in Europe,America and Japan;while resistance rates of Escherichia coli to all kinds of antibiotics were significantly higher than those of foreign countries.Bacterial resistance has been a widespread problem in our country,which regares much more attention.