蛇口地区2008~2010年常见细菌分布及耐药性分析

Bacteria distribution and drug resistance in Shekou area of Shenzhen City,2008-2010

目的分析了解深圳蛇口地区2008~2010年3年间临床常见细菌分布及耐药性变化情况,为临床合理用药和有效控制感染提供依据。方法对2008~2010年从临床分离的菌株进行鉴定以及测定其常用抗生素的药敏情况,再进行统计分析。结果检出细菌以革兰阴性菌为主,占70.5%,革兰阳性菌占29.5%,检出率从高到低依次为大肠埃希菌28.6%;肺炎克雷伯菌12.8%;表皮葡萄球菌5.5%;金黄色葡萄球菌5.0%。药敏情况如下:3年间革兰阴性菌中大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的检出率分别平均是26.0%和28.8%,3年间变化不明显(P>0.05),大肠埃希菌对阿米卡星耐药率由7.6%上升到13.7%,对阿莫西林/克拉维酸耐药率由7.0%上升到16.1%,对头孢西丁耐药率由12.0%上升到21.7%,对头孢吡肟耐药率由16.6%上升到33.6%,对头孢唑啉耐药率由26.0%上升到41.9%,对哌拉西林/他唑巴坦耐药率由5.9%上升到19.9%,耐药率最高是氨苄西林和哌拉西林,耐药率在70%左右,其他抗生素如环丙沙星等这3年来变化不大(P>0.05);革兰阳性菌中耐甲氧西林细菌MRSE、MRSA明显上升(P<0.01),分别由43.2%、29.0%上升到68.5%、44.6%。表皮葡萄球菌和金黄色葡萄球菌对阿莫西林/克拉维酸、复方新诺明、红霉素、四环素、头孢唑林耐药率均大于50%,对万古霉素敏感。结论本地区3年来细菌检出率革兰阴性菌高于革兰阳性菌,革兰阴性菌中ESBLs菌株检出率近3年中呈平稳趋势,大肠埃希菌耐药率提高,并具有多重耐药特性;革兰阳性菌MRSE、MRSA明显上升,对多种抗生素耐药性升高,未检出万古霉素耐药株。

Objective To survey the antibiotic resistance of clinically isolated from Shekou,in Shenzhen City, 2008-2010. Methods The pathogens clinically isolated from Shekou hospital in 2008-2010 were determined and analyzed with MicroScan auto SCAN 4 microbial and NC31 ,PC20 bacterial identification and susceptibility plates. Results A total of 3 569 strains isolated from Shekou [-[ospit~ with Gram-negati,~e bacteria （70.5%） and Gram-positb^e bacteria （29.5%）. The top four pathogens were E. coli （28.6%）,K. pneumoniae （12.8%）,S. epidermidis （5.5%）S. aureus （5.0%）. In Gram-negative bacteria,the isolated rate of ESBLs-producing E. coli and K. pneumoniae in 2008-2010 were 26.0% and 28.8%, respectively, showing no significantly difference within three years （P〉0.05）. Resistance rate of E. coli was on the rise to the amikacin （from 7.6% to 13.7%）,to amoxicillin / clavulanic acid （from 7.0% to 16.1%）,to cefoxitin （from 12.0% to 21.7%）, to eefepime （from 16.6% to 33.6%）, to cefazolin （from 26.0% to 41.9%） , to piperaciUirdtazobactam （from 5.9% to 19.9% ）.The resistance to ampicillin and piperacillin possessed highest （about 70% ）,however,resistance to ciprofloxacin changed little within these three years （P〉0.05）. In Gram-positive bacteria,MRSE resistant to methicillin and MRSA increased significantly （P〈0.01） from 43.2%,29.0% to 68.5%,44.6%,respecitvely. Resistance rates of S.epidermidis and S. aureus to amoxicillin /clavutanic acid, cotrimoxazole, erythromycin,tetracycline,cefazolin was over 50%, and the two strains sensitive to vancomycin were found. Conclusion The bacterial detection rate of Gram-negative bacteria was higher than Gram-positive bacteria at Shekou area in 2008-2011. In gram-negative bacteria,the detection rate of ESBLs strains showed a smooth ~＇end during the past three years,resistance rate of E. coli has improved and showed multi-drug resistance; meanwhile,in gram-positive bacteria,MRSE,MRSA increased obviously,resistance to multiple antibiotics increased significantly, and vancomycin-resistant strains were not detected.