CHINET2011年北京协和医院细菌耐药性监测

CHINET surveillance of antibiotic resistance in clinical isolates in Peking Union Medical College Hospital during 2011

目的了解北京协和医院临床分离细菌对抗菌药物的耐药性。方法除葡萄球菌属细菌采用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,用WHONET5.4软件统计分析。结果 2011年共收集非重复临床分离菌5 838株,其中革兰阴性菌4 288株,占73.4%,革兰阳性菌1 558株,占26.6%。取自呼吸道标本所占比率最高(49.2%),其次为尿液(11.9%)和血液(10.5%)。排在前6位的细菌依次为大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、金葡菌和阴沟肠杆菌,分别占17.6%、12.0%、11.8%、10.3%、10.0%和4.6%。大肠埃希菌、克雷伯菌属细菌(肺炎克雷伯菌、产酸克雷伯菌)和奇异变形杆菌的ESBLs检出率分别为52.3%、28.8%和24.2%。产ESBLs株对大多数抗菌药物的耐药率比非产ESBLs株高。肠杆菌科细菌中出现对亚胺培南和美罗培南耐药的菌株。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为20.3%和15.5%。鲍曼不动杆菌除对米诺环素耐药率为19.2%外,对其他抗菌药物的耐药率均大于50%。鲍曼不动杆菌中泛耐药株的检出率为42.7%。甲氧西林耐药金葡菌和凝固酶阴性葡萄球菌在各自菌种中的检出率分别为32.8%和76.3%。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。屎肠球菌对多数药物的耐药率均高于粪肠球菌。肺炎链球菌中青霉素耐药株占3.5%。各组溶血性链球菌除对红霉素、克林霉素外,对多数测试的抗菌药物均较为敏感。结论细菌耐药性呈增长趋势,应重视耐药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 2011. Methods Disc diffusion method was used to conduct antimicrobial susceptibility testing for all the bacterial strains except Staphylococcus which was tested by using the Phoenix 100. All the data were analyzed by WHONET 5.4 software ac- cording to the breakpoints of CLSI 2011. Results A total of 5 838 nonduplicate clinical isolates were collected during 2011, of which gram negative rods and gram positive cocci accounted for 73.4% and 26.6%, respectively. The main source of the pathogens was respiratory specimens （49.2%）, followed by urine （11.9%） and blood （10. 5%）. Escherichia coli （17.6%） was the most frequently isolated bacteria, followed by Acinetobacter baumannii （ 12.0 % ）, Pseudomonas aeruginosa （ 11.8 % ） , Klebsiella pneumoniae （ 10.3 % ）, Staphylococcus aureus （ 10.0 % ）, and Enterobacter cloacae （4.6 % ）. The prevalence of ES- BI.s was 52.3% in E. coli, 28.8% in Klebsiella spp. （Klebsiella pneurrzoniae, Klebsiella oacytoca ） and 24.2% in Proteus rnirabilis. ESBLs positive strains were more resistant to most antibiotics than the ESBLs negative strains. Some Enterobacteri- aceae strains were resistant to imipenem or meropenem. The percentage of the P. aeruginosa strains resistant to imipenem and meropenem were 20.3% and 15.5%, respectively. More than 50% of the A. baurnannii strains were resistant to all the antibiotics tested except minocycline, to which only 19.2% were resistant. The prevalence of pandrug resistant strains was 42.7% in A. baumannii. Methicillin-resistant strain was found in 32.8% of the Staphylococcus aureus （MRSA） isolates and 76.3% in the coagulase-negative Staphylococcus （MRCNS） isolates. No staphylococcal strain was resistant to vancomycin, teicoplanin or linezolid. More of the E. Jaecium strains were resistant to most of the antibiotics tested than E. faecalis.The prevalence of penicillin resistant Streptococcus pneumoniae （PRSP） strains ~as 3. 5~. 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 the rational use of antibiotics.