湖北十堰地区2010年临床分离菌的耐药性调查

Surveillance of drug resistance by clinical isolates from Hubei Shiyan region in 2010

目的调查湖北省十堰地区2010年临床分离病原菌的构成与耐药状况。方法细菌和真菌药敏试验分别采用Kirby-Bauer、Rosco纸片扩散法;产β-内酰胺酶和产超广谱β-内酰胺酶(ESBLs)菌株分别采用头孢硝基噻吩(cephalosporins nitrocefi n)试验、酶抑制剂增强纸片法确认;按CLSI 2010版判断结果。结果所分离2222株病原菌中,革兰阴性杆菌、革兰阳性球菌、真菌分别占65.2%、19.9%和14.9%。阴性杆菌中,大肠埃希菌、肺炎克雷伯菌的产ESBLS比率分别为64.2%、51.8%;检出多重耐药与泛耐药鲍曼不动杆菌的比率分别为82.7%和9.1%。革兰阳性球菌中,检出耐甲氧西林的金葡菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)分别为47.1%和86.2%,未发现万古霉素和利奈唑胺耐药葡萄球菌株;亦未发现耐万古霉素和利奈唑胺的肠球菌株。真菌感染中,81.2%为白念珠菌,其对两性霉素B、制霉菌素敏感率高于95%。结论十堰地区MRSA检出率低于其它地区,而多重耐药和泛耐药鲍曼不动杆菌的检出率较高。

Objective To investigate the composition and the drug-resistant status of pathogenic isolated from clinical specimens in Hubei Shiyan region in 2010. Methods The antibiotic susceptibility of bacteria and fungi were detected by Kirby-Bauer and Rosco disk diffusion method respectively. The strains producing beta-lactamases and extended spectrum-beta-lactamases （ESBLs） were identified by cephalosporins nitrocefin and enzyme-inhibitor enhanced disk method respectively. Results were analyzed according to CLSI 2010. Results In total of 2,222 pathogenic isolated, gram negative bacilli, gram positive cocci and fungi accounted for 65.2%, 19.9% and 14.9% respectively. In gram negative bacilli, the E.coli and K. pneumoniae producing extended spectrum-beta-lactamases accounted for 64.2% and 51.8%. The isolated rates of multi-drug resistant and pan-drug resistant for A. baumani were 82.7% and 9.1%. In gram positive cocci, methicillin-resistant strains in S. aureus （MRSA） and methicillin-resistant coagulase negative Staphylococcus （MRCNS） accounted for 47.1% and 86.2%. None of the isolated Staphylococcus and Enterococcus strains resistant to vancomycin or linezolid was found. The Candida albicans accounted for 81.2% of fungus infection and more than 95% of the Candida albicans was susceptible to amphotericin B and nystatin. Conclusions The isolated MRSA in Shiyan region was less than in other regions. While, the isolation rate of multidrug resistant and pan-drug resistant A. baumani was higher than other regions.