新疆喀什地区2010年细菌耐药性监测分析

Surveillance of antibiotic resistance in Kashi Prefecture,Xinjiang Uygur Autonomous Region in 2010

目的了解新疆维吾尔自治区喀什地区2010年2家地区级医院临床分离株的耐药情况。方法采用纸片扩散法（K-B法）对临床分离株进行药敏试验,采用CLSI 2009年版判断标准。结果 2 768株临床分离株中,革兰阳性菌占34.57%,革兰阴性菌占65.43%。排名前6位的病原菌是：大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、表皮葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌。146株铜绿假单胞菌对亚胺培南、美罗培南的耐药率分别为8.46%和10.00%,对阿米卡星、哌拉西林/他唑巴坦、妥布霉素的耐药率在14.94%-17.36%;对136株鲍曼不动杆菌耐药率小于30%的药物从低到高分别为美洛培南、阿米卡星、亚胺培南、哌拉西林/他唑巴坦、妥布霉素;MRSA占所有金黄色葡萄球菌的38.89%,葡萄球菌属未发现对万古霉素、利奈唑胺的耐药菌株;发现4株屎肠球菌和4株粪肠球菌对万古霉素耐药,但对利奈唑胺均敏感。结论喀什地区的抗生素耐药率与全国情况稍有差别,如铜绿假单胞菌及鲍曼不动杆菌对碳青霉烯类耐药率明显低于全国水平,可能与经济情况相关。但细菌耐药性普遍存在,亦发现了多耐药及泛耐药菌株,因此加强抗菌药耐药监测是目前合理应用抗生素的当务之急。

Objective To investigate the pathogens distribution and the antibiotic resistance of clinical isolated isolates from two hospitals of Kashi Prefecture,the Xinjiang Uygur Autonomous Region in 2010.Method Antimicrobial susceptibility was determined by Kirby-Beuer method and results were analyzed according to CLSI 2009.Results Of total 2 768 clinical isolates,Gram positive cocci accounted for 34.57% and Gram negative organisms for 65.43%.The top six pathogens were E.coli,S.aureus,K.pneumoniae,S.epidermisdis,P.aeruginosa and A.baumannii.The resistance of 146 P.aeruginosa isolates to Imipenem and Meropenem were detected with 8.46% and 10.00%respectively.And amikacin,Piperacillin/Tazobactam and tobramycin against P.aeruginosa were from 14.94% to 17.36%.The resistance of 136 A.baumannii isolates to Meropenem,amikacin,Imipenem,Piperacillin/Tazobactam,tobramycin in sequence from low to high were less than 30%.The isolate rate of MRSA was 38.89% No Staphylococcus strains resistant to vancomycin and Linezolid were found.4 strains of Enterococcus faecium and 4 strains of Enterococcus faecalis were resistant to vancomycin but sensitive to Linezolid.Conclusion The resitance rate of P.aeruginosa and A.baumannii in Kashi were significantly lower than nationwide level,perhaps correlated to local economic status.But the antibiotic resistance is on the rise with multidrug resistance and even pan-drug resistance.Therefore,surveillance on bacterial resistance is most important for controlling the upward resistance rate and rational antimicrobial therapy.