2010年武汉同济医院细菌耐药性监测

Surveillance of antimicrobial resistance in clinical isolates from Wuhan Tongji Hospital during 2010

目的分析武汉同济医院2010年临床分离菌对常用抗菌药物的耐药情况。方法采用纸片扩散法(K-B法)进行抗菌药物敏感性试验,E试验检测肺炎链球菌对青霉素和头孢曲松以及葡萄球菌对万古霉素的最低抑菌浓度(MIC),用WHO-NET5.4统计软件进行数据分析。结果 2010年该院5 287株临床分离菌中,革兰阳性球菌1 476株,占27.9%,革兰阴性杆菌3 149株,占59.6%,真菌662株,占12.5%。门诊病人前5位分离菌依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、金葡菌和流感嗜血杆菌,住院病人前5位分离菌依次为大肠埃希菌、金葡菌、铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌。MRSA和MRCNS的检出率分别为63.3%和74.7%;产ESBLs大肠埃希菌和克雷伯菌属的检出率分别为80.1%和55.6%,产酶株耐药性明显高于非产酶株;检出对万古霉素和(或)替考拉宁耐药的肠球菌属11株,经PCR检测均为VanA型。屎肠球菌耐药率均明显高于粪肠球菌(P<0.05);青霉素不敏感肺炎链球菌(PNSSP)分离率为33.0%(非脑脊液标本);铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为18.5%和14.3%,不动杆菌属对亚胺培南和美罗培南耐药率在50%以上;流感嗜血杆菌产β内酰胺酶阳性率为31.9%,除对氨苄西林和甲氧苄啶-磺胺甲口恶唑敏感率较低外,对其他抗菌药物敏感率均在75%以上。结论临床常见病原菌仍以革兰阴性杆菌为主,与该院往年监测数据相比,本年度分离的病原菌对多数抗菌药物耐药性呈上升趋势,多重耐药情况严重,出现少数耐万古霉素肠球菌属及多重耐药革兰阴性杆菌,应引起临床重视。

Objective To investigate the antibiotic resistance in the clinical strains isolated from Tongji Hospital to the antimicrobial agents commonly used in 2010.Methods Antimicrobial susceptibility was tested by Kirby-Bauer method.The minimum inhibitory concentrations（MICs） of penicillin and ceftriaxone for S.pneumoniae and vancomycin for Staphylococcus spp.were determined by E-test.All data were analyzed by WHONET5.4 software.Results A total of 5 287 strains were isolated during 2010,including gram-positive cocci（1 476,27.9%）,gram-negative bacilli（3 149,59.6%）,and fungus（662,12.5%）.The top five pathogenic bacteria isolated from outpatients were Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Staphylococcus aureus and Haemophilus influenzae,while the top five pathogens isolated from inpatients were Escherichia coli,Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii and Klebsiella pneumoniae.The prevalence of MRSA and MRCNS was 63.3% and 74.7%,respectively.The prevalence of ESBLs-producing Escherichia coli and Klebsiella pneumoniae was 80.1% and 55.6%,respectively.ESBLs-producing strains were more resistant than non-ESBLs-producing strains.Vancomycin resistance（VanA type） was identified by PCR in 11 strains of Enterococcus.The percentage of antibiotic-resistant E.faecium strains was significantly higher than that of E.faecalis（P 0.05）.The prevalence of penicillin nonsusceptible Streptococcus pneumoniae（PNSSP） was 33.0%（non-meningitis strains）.The percentage of Pseudomonas aeruginosa strains resistant to imipenem and meropenem was 18.5% and 14.3%,respectively.The percentage of Acinetobacter baumannii strains resistant to imipenem and meropenem was higher than 50%.More than 75% of Haemophilus influenzae isolates were susceptible to most antibiotics except ampicillin and trimethoprim-sulfamethoxazole.The prevalence of β-lactamases was 31.9% in these Haemophilus influenzae isolates.Conclusions Most isolates collected in our hospital during 2010 were gram-negative bacilli.The prevalence of multi-drug resistant strains is increasing compared to previous years,especially the increase of vancomycin-resistant Enterococcus and multi-drug resistant gram-negative bacilli.