卫生部全国细菌耐药监测网2011年胆汁培养病原菌耐药监测

Ministry of Health National Antimicrobial Resistance Investigation Net annual report of 2011:bacterial distribution and resistance in biliary tract infections

目的了解我国胆道感染病原菌分布和对常用抗菌药物的耐药现状。方法 2011年度从149所医院胆汁分离的病原菌进行药敏测定,数据用WHONET5.5软件进行统计分析。结果共分离8265株病原菌,其中革兰阴性杆菌5822株,占70.4%,革兰阳性球菌2443株,占29.6%。最常见的革兰阴性杆菌是大肠埃希菌(25.3%)、肺炎克雷伯菌(11.4%)和铜绿假单胞菌(9.4%);最常见的革兰阳性球菌是粪肠球菌(8.6%)和屎肠球菌(7.2%)。大肠埃希菌和肺炎克雷伯菌对头孢噻肟耐药率为67.7%,58.7%,对头孢吡肟的耐药率分别为28.9%,24.8%。大肠埃希菌对左氧氟沙星耐药率为56.3%,对2种碳青霉烯类耐药率小于2%。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率为6.1%～7.7%。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南耐药率分别为39.2%,79.4%。屎肠球菌和粪肠球菌对万古霉素的耐药率分别为2.0%,1.5%。结论我国胆道感染病原菌以大肠埃希菌、肠球菌属和肺炎克雷伯菌最常见,肺炎克雷伯菌对碳青酶烯类药物耐药率有明显增加,耐糖肽类的肠球菌分离率仍较低。

Objective To investigate distribution and antibiotic resist- ance of bacteria that was cultured from bile in China . Methods Bile cultures and antimicrobial sensitivity tests for isolated strains were per- formed in 149 Mohnarin member hospitals using standard protocols during 2011. Data was collected and analyzed by using WHONET 5.5 software. Results A total of 8265 bacterial strains were isolated during the study period, including 5822 strains （70.4%） of gram - negative bacilli and 2443 （29.6%） strains of gram- positive cocci. The top three gram- negative bacillii were Escherichia coli （25.3%）, Klebsiella pneumoniae （ 11.4% ） and Pseudomonas aeruginosa （9.4%） , whereas the most fre- quently isolated gram -positive cocci were Enterococcus faecalis （8： 6% ） and E.faecium （7.2%） . Susceptibility test results showed that the highest resistant rates of E. coli and K. pneumoniae to cefotaxime among the third - generation cephalosporin, were 67.7% and 58.7% . The re- sistance rates to cefepime were 28.9% and 24.8% respectively. Resist- ance rate of E. coli to levofloxacin was 56. 3%, and resistance rates to the two kinds of carbapenems were less than 2.0%. K. pneumoniae were resistant to imipenem and meropenem , with the rates of 7.7% and6. 1% respectively. For non - fermenting gram - negative isolates, resistant rates of P. aeruginosa and A. baumaii to imipenem were 39.2% and 79.4%. The resistance rates of E. faecium and E. faecalis to vancomycin were 2.0% and 1.5%. Conclusion The most common pathogens of from bile culture were E. coli, Enterococcus and K. pneumonia in China in 2011. The resistance rates of K. pneumoniae to carbapenem was increased compared with the data of last year. Number of Glycopeptide resistant Enterococcus strains werw still rarely isolated.