Mohnarin 2009年度报告:广东地区细菌耐药监测

Mohnarin 2009 annual report:Bacterial distribution and resistance surveillance in Guangdong China

目的了解2009年广东地区细菌耐药性监测网所属22所医院临床分离株的耐药情况。方法用纸片扩散法(KB法)对26004株临床分离株作药敏试验。结果 26004株细菌中,革兰阳性菌占35.7%;革兰阴性菌占64.3%。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为58.8%和53.6%。未发现万古霉素中介株(VISA)或耐药株(VRSA)。肺炎链球菌(非脑膜炎分离株)对青霉素耐药率为2.4%。肠杆菌科细菌对碳青霉烯类保持最低耐药性。在大肠埃希菌和克雷伯菌属中,产ESBLs菌的检出率分别为47.7%和42.6%;二甲医院大肠埃希菌ESBL发生率(52.8%)高于三甲医院(45.0%)(χ2=18.2,P<0.01)。对铜绿假单胞菌耐药率最低的依次是美洛培南(16.5%)、头孢哌酮/舒巴坦(16.9%)和哌拉西林/他唑巴坦(19.0%)。对不动杆菌属耐药率最低的依次是头孢哌酮/舒巴坦(11.2%)、米诺环素(18.2%)和亚胺培南(24.3%)。与2007年本地资料相比,不动杆菌属对亚胺培南的耐药率已由7.1%增加至24.7%,其余菌种耐药性相对稳定。结论不动杆菌属对碳青霉烯类耐药问题日趋严峻。

Objective To investigate antimicrobial resistance of clinical isolates from 22 hospitals submitted to Guangdong surveillance of antimicrobial resistance in 2009. Methods Disc diffusion test （ K - B methods） was employed to study the antimicrobial resistance. WHONET 5.4 was applied for analysis. Results Of 26004 clinical isolates, Gram neg- ative bacilli and Gram positive cocci accounted for 64. 3% and 35.7%, respectively. The detection rates of methicillin - resistant strains was 58.8% in S. aureus and 53.6% in conagulase negative Staphylococcus. No VISA or VRSA isolate was found. Two point four percent S. pneumoniae isolates were penicillin -resistant （PRSP） according to 2009 CLSI criterion. The resistant rates of enterobacter to carbpenem were the lowest. The prevalence of ESBLs - producing strains in E. coli and, Klebsiella spp. isolates was 47.7% and 42. 6%, respectively. The prevalence of ESBLs -producing strains in E. coli in teaching hospitals was higher than that in community hospitals. The resistance rates of P. aeruginosa to meropenem, cefoperazone/sulbactam and piperacillin/ tazobactam were 16. 5% ,16. 9%and 19. 0%, respectively and 24. 3% , 11.2% and 34. 3% for A cinetobacter spp. , respectively. Compared with data in 2007, the resistant rates of A cinetobacter spp. to imipenem was increased from 7. 1% to 24. 7% in 2009, while other organisms kept stable resistance to antibiotics. Conclusion Emergence and spread of Acinetobacter species, resistant to most of the available antimicrobial agents, is an area of great concern.