Mohnarin 2011年度报告:门急诊患者细菌耐药性监测

Mohnarin report of 2011:bacterial resistance surveillance of emergency and outpatient isolates

目的了解我国门急诊患者分离菌对抗菌药物的耐药性,以指导临床应用抗菌药物。方法采用纸片、MIC或E-test法测定细菌药物敏感性,使用WHONET5.6软件进行数据分析,对卫生部全国细菌耐药性监测网(Mohnarin)所属49所三级甲等医院2011年1月1日-12月31日门急诊来源的细菌药物敏感性进行分析。结果共分离病原菌6878株,其中革兰阳性菌2380株占34.6%,革兰阴性菌4498株占65.4%,前5位分离株为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌和粪肠球菌,分别占33.0%、9.5%、7.5%、7.1%和6.2%;耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别为31.0%和81.0%,未发现耐万古霉素金黄色葡萄球菌和凝固酶阴性葡萄球菌;2.1%屎肠球菌对万古霉素耐药;链球菌属主要对大环内酯类与克林霉素耐药,β-溶血链球菌和酿脓链球菌对左氧氟沙星耐药率>30.0%;流感嗜血菌对氨苄西林耐药率23.5%;大肠埃希菌和肺炎克雷伯菌耐药率低于同期整体监测水平;铜绿假单胞菌对各种抗菌药物的耐药率低于同期整体监测水平。结论我国门急诊来源致病菌以葡萄球菌属、大肠埃希菌、铜绿假单胞菌和金黄色葡萄球菌多见;细菌耐药较住院患者低,但主要细菌耐药性较为突出。

OBJECTIVE To explore the bacterial resistance in emergency and outpatient isolates in China so as to provide basis for the clinical use of antibiotics.METHODS Disc diffusion test,MIC test and E-test were used to detect the antimicrobial sensitivity of bacteria isolates from emergency and outpatients patients.WHONET 5.6 was applied for analyzing the bacterial sensitivity data from 49 tertiary care Mohnarin member hospitals in China from Jan 1,2011 to Dec 31,2011.RESULTS A total of 6878 bacterial strains were isolated in the survey period,which included 2380（34.6%） gram-positive and 4498（65.4%） gram-negative strains.Escherichia coli,Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella pneumoniae and Enterococcus faecalis were the top 5 species of pathogens,accounting for 33.0%,9.5%,7.5%,7.1%,and 6.2%,respectively.Methicillin-resistant S.aureus and coagulase-negative Staphylococci were 31.0% and 81.0%,respectively;no vancomycin-resistant Staphylococcus were detected.The resistant rates of Enterococcus faecium to vancomycin were 2.1%.Streptococcus spp.were mainly resistant to macrolides and clindamycin and the resistant rates of β-hemolytic Streptococcus and Streptococcus viridans to levofloxacin were over 30.0%;the resistant rate of Hamophilus influenzae to ampicillin was 23.5%;the resistant rates of E.coli,K.pneumoniae and P.aeruginosa were lower than those of the overall bacterial isolates.CONCLUSION Escherichia coli,S.aureus,P.aeruginosa,K.pneumoniae and E.faecalis are the predominant pathogens isolated from outpatient and emergency patients in China.The drug resistance rates of the strains isolated from the hospitalized patients are relatively low,but which of the main species of bacteria are outstanding.