2010年河南省中原地区临床分离菌耐药监测分析

Surveillance and analysis of drug resistance of clinical isolates from central Henan province in 2010

目的了解2010年河南省中原地区临床分离菌的分布及耐药性,指导临床合理使用抗菌药物。方法采用纸片扩散法(K-B法)或自动化仪器法对2010年河南省中原地区7所医院临床分离菌株进行药敏试验及ESBLs的检测,按CLSI 2008年标准判定药敏结果,并用WHONET 5.4软件进行数据分析。结果 7所医院共分离病原菌5014株,其中革兰阴性杆菌3402株占67.9%,革兰阳性菌1612株占32.1%;大肠埃希菌、凝固酶阴性葡萄球菌(CNS)、铜绿假单胞菌、金黄色葡萄球菌(SAU)、克雷伯菌属为最常见临床分离菌,分别占20.6%、16.2%、11.4%、9.2%、9.2%;大肠埃希菌、克雷伯菌属和奇异变形菌中ESBLs的检出率分别为48.7%、36.2%和18.1%;葡萄球菌属中MRSA和MRSCN的检出率分别为67.4%和81.4%;SAU和CNS对青霉素、大环内酯类、磺胺甲噁唑/甲氧苄啶等高度耐药,对呋喃妥因、利福平耐药率较低,未见耐万古霉素葡萄球菌;肠球菌属对万古霉素、呋喃妥因、氨苄西林、青霉素耐药率依次为0.9%、27.0%、36.0%和41.4%,庆大霉素高耐药株已达67.6%。结论该地区细菌耐药性仍呈上升趋势,定期对该地区细菌耐药性进行监测,对合理使用抗菌药物、减少耐药菌株的产生和流行有重要价值。

OBJECTIVE To investigate the distribution and drug resistance of clinical isolates in central Henan province in 2010 for the guidance of rational application of antibacterials.METHODS The drug susceptibility testing and the detection of extended-spectrum β-lactamase（ESBLs） of clinical isolates from 7 hospitals in central part of Henan were performed using K-B method or automated system.The results were analyzed by WHONET5.4 according to CLSI 2008.RESULTS Of 5014 clinical isolates,3402 strains（67.9%） were gram-negative bacilli and 1612 strains（32.1%）were gram-positive cocci.E.coli,coagulase-negative Staphylococcus（CNS）,P.aeruginosa,S.aureus（SAU） and Klebsiella spp were the most common clinical isolates,accounting for 20.6%,16.2%,11.4%,9.2% and 9.2%,respectively.The detection rates of ESBLs were 48.7% in E.coli,36.2% in Klebsiella spp and 18.1% in P.mirabilis isolates;The detection rates of MRSA and MRSCN in Staphylococcus were 67.4% and 81.4%,respectively.SAU and CNS were highly resistant to penicillin,macrolides and sulfamethoxazole/trimethoprim,but lowly resistant to nitrofurantoin and rifampicin,with no vancomycin-resistant Staphylococcus strains.Resistant rates of Enterococcus spp to vancomycin,nitrofurantoin,ampicillin and pennicillin were 0.9%,27.0%,36.0% and 41.4%,respectively.And the resistant rate of isolates to gentamicin reached 67.6%.CONCLUSION The bacterial resistance in central Henan province is still increasing.Therefore,regular surveillance of bacterial resistance is of great importance for the rational use of antibiotics and the reduction of production and spread of drug-resistant isolates.