Mohnarin 2009年度报告:女性尿标本来源细菌耐药监测

Mohnarin 2009 annual report:Bacterial resistances in women urine tract infections

目的总结我国2009年临床女性尿标本来源细菌耐药状况。方法常规方法,培养分离卫生部全国细菌耐药性监测网(Mohnarin)所属114家医院2009年度女性尿标本中的细菌,用自动化临床微生物测定方法、纸片法或E-test法,测定细菌药物敏感性,用WHONET 5.5软件对女性尿标本中分离细菌对抗菌药物敏感性进行分析。结果共分离细菌13391株,其中排在前5位的依次为大肠埃希菌49.20%、粪肠球菌7.82%、屎肠球菌7.33%、肺炎克雷伯杆菌6.11%及奇异变形杆菌3.35%。对大肠埃希菌耐药率较低的抗生素,依次为碳青霉烯类0.4%、哌拉西林/他唑巴坦3.5%、头孢哌酮/舒巴坦5.7%、阿米卡星7.2%、呋喃妥因8.4%、头孢西丁12.8%、阿莫西林/克拉维酸18%及磷霉素18.8%。对肠球菌耐药率较低的抗生素,依次为利奈唑胺0.59%～0.8%、糖肽类0.27%～4.7%、磷霉素23.5%及呋喃妥因6.98%～43.1%。结论泌尿系统感染的主要致病菌,仍为大肠埃希菌;但肠球菌的比例明显升高。抗生素耐药总体结果严重,口服抗生素经验性治疗,可选用呋喃妥因、磷霉素和阿莫西林/克拉维酸;注射剂经验性治疗,可选用加酶抑制剂的联合制剂、头霉素类和碳青霉烯类。

Objective To summarize bacterial resistance in the women clinical urine culture samples collected in 2009 from 114 Hospitals of Ministry of Health Antibiotic Resistance Monitoring Network（Mohnarin）.Method Conventional culture,automatic clinical microbiological system,disk diffusion and E-test methods were used for antibacterial activity of antimicrobial agents and resistances and sensitivity were calculated by using WHONET5.5 software.Results A total of 13391 strains of bacteria were isolated,of which 49.20% of E.coli,Enterococcus faecalis 7.82%,Enterococcus faecium 7.33%,Klebsiella pneumonia 6.11% and Proteus mirabilis 3.35%,respectively.The antimicrobial agents with lower antibiotic resistance rates of E.coli were carbapenems（0.4%）,piperacillin / tazobactam（3.5%）,cefoperazone / sulbactam（5.7%）,amikacin（7.2%）,nitrofurantoin（8.4%）,cefoxitin（12.8%）,amoxicillin / clavulanic acid（18%） and fosfomycin（18.8%）,respectively.That of Enterococcus spp.were linezolid（0.59%-0.8%）,glycopeptides（0.27%-4.7%） fosfomycin（23.5%） and nitrofurantoin（6.98%-43.1%）,respectively.Conclusion E.coli remains the urinary tract infection major pathogen but the proportion of enterococci was significantly increased.The overall results of antibiotic resistance were serious.Nitrofurantoin,fosfomycin and amoxicillin / clavulanic acid can be chose as empirical treatment of oral antibiotics.Antimicrobial agents with enzyme inhibitor and carbapenems can be chose as empirical treatment of injection antibiotics.