2009年重庆医科大学附属第一医院细菌耐药监测

Surveillance of bacterial resistance from the first affiliated hospital of Chongqing Medical University in 2009

目的调查我院2009年临床分离病原菌对抗菌药物的耐药性。方法采用纸片扩散法进行抗菌药物敏感实验,采用WHONET5.4软件及SPSS13.0软件进行数据分析。结果临床分类的1608株病原菌中,革兰阳性菌占25.1%,革兰阴性菌占74.9%;耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌株检出率分别为63.7%和93.7%;未发现对万古霉素或替考拉宁中介或耐药的葡萄球菌和肠球菌菌株。大肠埃希菌、肺炎克雷伯菌ESBLs检出率分别为57.2%、56.8%,肺炎克雷伯菌ESBLs的菌株高于2008年监测比例,且差别具有统计学意义(P<0.05)。鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率在55%以上。结论革兰阳性细菌对万古霉素、替考拉宁、利奈唑胺均敏感;肠杆菌对碳青霉烯类敏感性高;铜绿假单胞菌对阿米卡星敏感、头孢哌酮/舒巴坦相对敏感,鲍曼不动杆菌对碳青霉烯类耐药率高,对头孢哌酮/舒巴坦敏感性高。未发现泛耐药菌株。

Objective To investigate the bacterial resistance of clinical isolates from the first affiliated hospital of Chongqing Medical University in 2009. Methods Disk diffusion method was used to determine the antimicrobial susceptibility. And WHONET 5.4 and SPSS13.0 softwares were used to analyze the data. Results Of 1608 clinical isolates, Gram-positive organisms accounted for 25.1%, and Gram-negative organisms 74.9%. The detection rates of methicillin-resistant Staphylococcus aureus （MRSA） and coagulase-negative staphylococci （CNS） were 63.7% and 93.7%, respectively. No strains of staphylococci and enterococci were found resistant or intermediate to vancomycin and/or teicoplanin. Extended chain hemoglobinxtended-spectrum [3-1actamases （ESBLs） positive rates of Escherichia coli and Klebsiella spp. were 57.2% and 56.8%, respectively. ESBLs positive rate of Klebsiella spp was higher than that obtained in 2008, and the discrepancy was statistically significant （P〈0.05）. The carbapenem resistance rate in Acinetobacter spp. was more than 55%. Conclusions In our hospital, gram-positive bacteria are still susceptible to the vancomycin teicoplanin and linezolid. For Enterobacteriaceae spp., carbapenems are the most potent antimicrobialt, amikacin and cefoperazone/sulbactam rank the first and second efficacious drugs against Pseudomonas aeruginosa. Albeit the resistant rate of Acinetobacter baumannii to carbapenem is high, cefoperazone/sulbactam remains relatively sensitive. No Pan-drug resistant strains are found.