2009年中国13家教学医院院内感染病原菌的抗生素耐药性监测

Antimicrobial resistance surveillance among nosocomial pathogens in 13 teaching hospitals in China in 2009

目的监测2009年我国不同地区13家教学医院院内获得病原菌的分布和体外药物敏感性。方法收集来自13家医院院内BSI、HAP和IAI患者标本的病原菌。菌株经中心实验室复核后，采用琼脂稀释法测定替加环素等抗菌药物的MIC值，数据输入WHONET5．6软件进行耐药性分析。结果共收集到2502株病原菌。引起BSI的前3位病原菌分别为大肠埃希菌[27．1％（285／1052）]、凝固酶阴性葡萄球菌[12．6％（133／1052）]和肺炎克雷伯菌[10．8％（114／1052）]；引起HAP的前3位病原菌分别为鲍曼不动杆菌[28．8％（226／785）]、铜绿假单胞菌[16．1％（126／785）]和肺炎克雷伯菌[14．6％（115／785）]；而IAI的主要病原菌为大肠埃希菌[31．0％（206／665）]、肺炎克雷伯菌[11．3％（75／665）]和屎肠球菌[10．8％（72／665）]。对于大肠埃希菌和克雷伯菌，敏感率大于80％的药物包括亚胺培南和美罗培南（98．1％～100％）、替加环素（95．3％～100％）、哌拉西林－三唑巴坦（88．6％～97．1％）和阿米卡星（88．3％～92．5％）。对于肠杆菌属、柠檬酸杆菌属和沙雷菌属，替加环素的敏感率为93．5％～100％，亚胺培南和美罗培南的敏感率为92．9％～100％，敏感率较高的抗菌药物还包括阿米卡星（85．2％～96．7％）、哌拉西林一三唑巴坦（82．4％～96．4％）、头孢吡肟（79．6％～96．7％）和头孢哌酮一舒巴坦（78．7％～90．0％）。铜绿假单胞菌对多黏菌素B的敏感率最高（100％），其次为阿米卡星和哌拉西林－三唑巴坦（81．9％和80．1％）。鲍曼不动杆菌对多黏菌素B的敏感率最高（98．8％），其次为替加环素（90．1％）和米诺环素（72．0％）。CRAB的发生率为60．1％。金黄色葡萄球菌中MRSA的发生率为60．2％，凝固酶阴性葡萄球菌中MRSCoN的发生率为84．2％。所有葡萄球菌对替加环素、万古霉素和利奈唑胺敏感，仅有1株溶血葡萄球菌对替考拉宁中介。本次监测发现2株利奈唑胺中介的粪肠球菌和1株万古霉素和替考拉宁耐药的屎肠球菌，替加环素对这3株肠球菌的MIC值范围为0．032～0．064斗g／ml。结论替加环素、碳青霉烯类、哌拉西林－三唑巴坦、阿米卡星和头孢吡肟对医院分离的肠杆菌科菌保持了较高的抗菌活性；多黏菌素B对铜绿假单胞菌和鲍曼不动杆菌体现出高抗菌活性，替加环素对鲍曼不动杆菌抗菌活性较高；替加环素、万古霉素和替考拉宁、利奈唑胺对院内获得革兰阳性球菌保持了较高的抗菌活性。

Objective To investigate distribution and antimicrobial resistance among nosocomial pathogens from 13 teaching hospitals in China in 2009. Methods Non-repetitive pathogens from nosocomial BSI, HAP and IAI were collected and sent to the central lab for MIC determination by agar dilution method. WHONET5.6 software was used to analyze the data. Results A total of 2 502 clinical isolates were collected. The top three pathogens of BSI were Escherichia coli [ 27. 1% （ 285/1 052 ） ~ , coagulase-negative staphylococcus [ 12. 6% （ 133/1 052） 1 and Klebsiella pneumoniae [ 10. 8% （ 114/1 052） l- The top three pathogens of HAP were Acinetobacter baumannii [ 28.8% （226/785） ], Pseudomonas aeruginosa [ 16. 1% （126/785） I and Klebsiella pneurnoniae [ 14. 6% （115/785 ）1. The top three pathogens of IAI were Escherichia coli[ 3 i. 0% （ 206/665 ） ], Klebsiella pneumonia [ 11.3 % （ 75/665 ） ] and Enterococcus faecium [ 10. 8% （72/665） 1. Against Escherichia coli and Klebsiella spp. , the antimicrobial agents with higher than 80% susceptibility rate included imipenem and meropenem （98. 1%-100%）, tigeeycline （95.3%- 100% ） , piperacillin-tazobactam （88.6%-97. 1% ） and amikacin （88.3%-92. 5% ）. Against Enterobacter spp. , Citrobacter spp. and Serratia spp. , the susceptibility rates of tigecycline were 93.5%-100% whereas the value of imipenem and meropenem were 92. 9%-100%. Other antimicrobial agents with high activity included amikacin （ 85.2% -96. 7% ）, piperacillin-tazobactam （ 82. 4% -96. 4% ）, cefepime （ 79.6%- 96. 7% ） and cefoperazone-sulbactam （78.7%-90. 0% ）. Polymyxin B showed the highest susceptibility rate against Pseudornonas aeruginosa （ 100% ） , followed by amikacin （81.9%） and piperacillin-tazobactam （80. 1% ）, Polymyxin B also showed the highest susceptibility rate against Acinetobacter baumannii （98.8%） , followed by tigecycline （90. 1% ） and minocycline （72. 0% ）. The incidence of earbapenem- resistant Acinetobacter baumannii was 60. 1% . The MRSA rate was 60. 2% and the MRSCoN rate was 84. 2%. All Staphylococcus strains were susceptible to tigecycline, vancomycin, teicoplanin and linezolid except for one isolate of Staphylococcus haernolysis with intermediate to teicoplanin. Two Enterococcusfaecalis isolates which were intermediate to linezolid and one Enterococcus faecium isolate which was resistant to vancomycin and teicoplanin was found in this surveillance, while the MICs of tigecycline against these three isolates were 0. 032-0. 064 txg/ml. Conclusions Tigecycline, carbapenems, piperacillin-tazobactam, amikacin and cefepime remain relatively high activity against nosocomial Enterobacteriaceae. Pseudomonas aeruginosa exhibite high susceptibility to polymyxin B, while Acinetobacter baumanni shows high susceptibility to polymyxin B and tigecycline. Tigecycline, vancomycin, teicoplanin and linezolid remain high activity against nosocomial gram-positive cocci.