2010年上海地区细菌耐药性监测

Surveillance of bacterial resistance in Shanghai hospitals during 2010

目的了解上海地区16所医院2010年临床分离细菌的耐药情况。方法采用纸片扩散法(K-B法)对临床分离菌株作药敏试验。采用CLSI 2010年版标准判断结果。结果 41 326株临床分离株中,革兰阳性菌占30.3%,革兰阴性菌占69.7%。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)的检出率各自为57.9%和78.9%,未发现万古霉素、替考拉宁和利奈唑胺耐药株。656株肺炎链球菌中7株为脑脊液分离的肺炎链球菌,其余为非脑膜炎分离株。儿童分离株中PSSP占71.2%,PISP和PRSP分别占17.0%和11.8%。成人分离株中97.0%为PSSP,1株为PISP。发现15株万古霉素耐药屎肠球菌和6株万古霉素耐药粪肠球菌,其中分别有11株和5株为vanA型耐药,其余均为vanB型耐药。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌+产酸克雷伯菌)和奇异变形杆菌中产ESBLs分别占56.8%、40.8%和19.7%。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,对亚胺培南和美罗培南的总耐药率<5%。不动杆菌属对亚胺培南和美罗培南耐药率仍继续增高,耐药率分别为49.6%和51.2%。肺炎克雷伯菌和鲍曼不动杆菌中泛耐药菌株较2009年显著增多。结论细菌耐药性仍呈增长趋势,对临床构成严重威胁,采取积极有效防控措施为当务之急。

Objective To investigate the antibiotic resistance of clini cal isolates in Shanghai hospitals from January to December in 2010. Methods Antimicrobial susceptibility testing was carried out for 41 326 clinical isolates according to an agreed protocol using Kirby-Bauer （KB） method. Results were analyzed according to the breakpoints of CI.SI 2010. Results Of the 41 326 clinical isolates, gram negative ba- cilli and gram positive cocci accounted for 69.7% and 30.3%, respec tively. The prevalence of MRSA in S. aureus were 57. 9%, and 78. 9）% of the coagulase negative Staphylococcus isolates were methicillin- resistant （MRCNS）. No staphylococcal isolate was found resistant to vancomycin, teicoplanin or linezolid. Seven of the 656 strains of S. pneurnoniae were isolated from cerebrospinal fluid （meningitis strain）. The remaining were nonmeningitis strains. The prevalence of penicillin susceptible S. pneumoniae （PSSP） was 71.2% in the nonmeningitis strains from children. Penicillin-intermediate S. pneumoniae （PISP） and penicillin-resistant strains accounted for 17. 0% and 1 1.8%, respectively. The prevalence of PSSP and PISP were 97.0% and 3% in the nonmeningitis strains from adults. Fifteen strains of E. faecium and 6 strains of E. faecalis were found resistant to vaneomycin. Eleven of the 15 E. Faecium strains and 5 of the 6 E. faecalis strains showed van Atype resistance. The remaining strains were van Dtype resistance. ESBI.s production was confirmed in 56.8% of E. coli, 40.8% of Klebsiella spp. （K. pneumoniae and K. oxytoca） and 19.7% of P. mirabilis isolates. Enterobacteri- aceae isolates were still highly sensitive to carbapenem antibiotics. The percentage of the strains resistant to imipenem or meropenem was 〈5%. The resistance rate of Acinetobaeter spp. to imipenem and meropenem was increasing. About 49.6% and 51.2% of the strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2009, the prevalence of pan drug resistant K. pneumoniae and A. baumannii strains increased markedly. Conclusions Bacterial resistance is still increasing, which poses a serious threat to clinical practice. It is urgent to take effective infection control measures.