2011年四川省肿瘤医院细菌耐药性监测

Surveillance of bacterial resistance from Sichuan cancer hospital in 2011

目的了解2011年四川省肿瘤医院临床分离株对常用抗菌药物的耐药性。方法采用MIC法对1 582株临床分离株进行药敏试验。按美国临床实验室标准化协会2009版判读结果。结果 1 582株临床分离株中革兰阳性球菌占10.1%(160/1 582),革兰阴性杆菌占89.9%(1 422/1 582)。耐甲氧西林金黄色葡萄球菌(MR-SA)的检出率占金黄色葡萄球菌的26.1%。葡萄球菌中甲氧西林耐药株对β-内酰胺类抗菌药物和其他测试药的耐药率显著高于甲氧西林敏感株,未发现万古霉素和利奈唑胺耐药株。肠球菌属中屎肠球菌对多数测试药物的耐药率高于粪肠球菌,出现1株耐万古霉素菌株,无利奈唑胺耐药株。革兰阴性肠杆菌中,大肠埃希菌和克雷伯菌属产ESBLs株分别为66.5%和21.2%。产ESBLs菌株对大多β-内酰胺类抗菌药物高度耐药。亚安培南对肠杆菌科细菌抗菌活性最强。出现了较多的多重耐药鲍曼不动杆菌。结论该院细菌耐药性较2010年有增长趋势,尤其出现了耐万古霉素的肠球菌且多重耐药鲍曼不动杆菌显著增多,应引起注意,并及早采取防控措施。

Objective To investigate the resistance of clinical isolates from Sichuan cancer hospital in 2011. Methods Antimicrobial susceptibility testing of 1 582 clinical isolates were carried out by means of MIC and results were analysed according to CLSI（2009）. Results Of 1 582 clinical isolates,gram positive cocci and negative bacilli accounted for 10. 1~ and 89. 90/oo respectively. Methicillin resistant strains in S. aureus（MRSA） accounted for 26. 1 ~. The resistance rates of MRSA to ~lactams and other antimicrobial agents were much higher than those of methicillin-sensitive strains. No vaneomycin or linezolid resistant strains were found. In Enter ococcus spp,the resist- ance rates of E. faecium strains to most tested drugs were higher than those of E. faecalis. There was a strain resistant to vancomycin in E. faecium. No linezolid resistant strains were found. In enterobacteriaceae, ESBLs-producing strains accounted for 66.5~ and 21.2~ in E. coil and Klebsiella spp. respectively. ESBLs-producing strains were resistant to most 13-1actams and some other antimicrobial agents. Imipenem was the most potent antimicrobial agent. Many multi- drug resistant strains in A. baumannii were found. Conclusion Bacterial resistance is still increasing in the hospital, especially VRE and multi-drug resistant A. baumannii strains. It is mandatory for the hospital to take effective control measures.