2010年北京协和医院细菌耐药性监测

Surveillance of antibiotic resistance in clinical isolates from Peking Union Medical College Hospital during 2010

目的了解北京协和医院2010年临床分离细菌对抗菌药物的耐药性。方法除葡萄球菌属采用Pheonix 100测定其药物敏感性外,其余菌株均采用纸片扩散法,参照CLSI 2011年版判读结果,使用WHONET5.4软件统计分析。结果 2010年共收集非重复临床分离菌5 383株,其中革兰阴性菌占61.2%,革兰阳性菌占38.8%。呼吸道标本所占比率最高(37.0%),其次为尿液(12.8%)和血液(12.4%)。分离菌中排在前6位的依次为大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌和金葡菌,分别为18.8%、12.1%、11.8%、9.1%、7.5%和7.1%。大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌和奇异变形杆菌的产ESBLs阳性率分别为56.2%、30.4%、24.0%和17.4%。产ESBLs菌株对大多数抗菌药物的耐药率均比非产ESBLs菌株高。肠杆菌科细菌中出现对亚胺培南、美罗培南和厄他培南耐药的菌株。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为20.0%和15.3%。鲍曼不动杆菌除对米诺环素耐药率为17.7%外,对其他抗菌药物的耐药率均在59%以上。MRSA和MRSCN的检出率分别为43.4%和78.8%。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌属。屎肠球菌对多数药物的耐药率均高于粪肠球菌。儿童肺炎链球菌中PRSP占76.0%,较成人菌株明显为高。其他溶血性链球菌除红霉素、克林霉素外,对多数抗菌药物均较为敏感。结论细菌耐药性呈增多趋势,应重视细菌耐药性监测并加强抗生素的合理使用。

Objective To investigate the antimicrobial resistance of clinical isolates in Peking Union Medical College Hospital during 2010.Methods Antibiotic susceptibility testing was conducted by using disc diffusion method.The antimicrobial susceptibility of staphylococcal strains was tested by using Phoenix 100.All the data were analyzed by WHONET 5.4 software according to CLSI 2011 breakpoints.Results A total of 5 383 clinical isolates were collected during 2010,of which gram negative rods and gram positive cocci accounted for 61.2% and 38.8%,respectively.The most common specimen source was respiratory tract（37.0%）,followed by urine（12.8%） and blood（12.4%）.Escherichia coli was the most frequently isolated bacteria,followed by Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,coagulase-negative Staphylococcus,and Staphylococcus aureus,accounting for 18.8%,12.1%,11.8%,9.1%,7.5% and 7.1%,respectively.The prevalence of ESBLs in the strains of E.coli,Klebsiella pneumoniae,Klebsiella oxytoca and Proteus mirabilis was 56.2%,30.4%,24.0% and 17.4%,respectively.The resistance rates of ESBLs-positive strains to most antibiotics were higher than ESBLs-negative strains.Some strains of Enterobacteriaceae were resistant to imipenem,meropenem and ertapenem.The percentage of P.aeruginosa strains resistant to imipenem and meropenem was 20.0% and 15.3%,respectively.The percentage of A.baumannii strains resistant to all the antibiotics tested was above 59% except minocycline（17.7%）.The prevalence of methicillin-resistant Staphylococcus aureus（MRSA） and coagulase-negative Staphylococcus（MRCNS） was 43.4% and 78.8%,respectively.No strains were found resistant to vancomycin,teicoplanin or linezolid in Staphylococcus spp.The percentage of E.faecium strains resistant to most of the antibiotics tested was higher than that of E.faecalis.The prevalence of penicillin resistant Streptococcus pneumoniae（PRSP） was 76.0% in the isolates from children,which was significantly higher than in the isolates from adults.Hemolytic Streptococcus strains were more sensitive to most antibiotics except erythromycin and clindamycin.Conclusions Bacterial resistance is still on the rise.We should pay more attention to resistance surveillance and improve the rational use of antibiotics.