2011年四川大学华西第二医院细菌耐药性监测

Surveillance of Bacterial Resistance in West China Second University Hospital of Sichuan University in 2011

目的了解2011年四川大学华西第二医院临床分离菌对常见抗菌药物的耐药性。方法采用法国生物梅里埃公司VITEK 2 COMPACT全自动细菌鉴定药敏仪,以及ATB手工药敏条检测临床分离菌对各种常用抗菌药物的耐药性,参照CLSI 2011年版标准判定药敏试验结果,并用WHONET5.4软件统计分析。结果临床分离的1 692株细菌中,G+菌占28.0%(473/1 692),G菌占72.0%(1 219/1 692)。分离的前5位病原菌分别为大肠埃希菌、流感嗜血杆菌、肺炎克雷伯菌、肺炎链球菌、金黄色葡萄球菌。耐甲氧西林金黄色葡萄球菌和耐甲氧西林的凝固酶阴性葡萄球菌分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的15.1%(22/146)和76.7%(46/60),未检出万古霉素、利奈唑胺耐药株。屎肠球菌对所测抗菌药物的耐药性显著高于粪肠球菌,对氨苄西林的耐药率分别为95.7%和13.3%,高水平氨基糖苷类抗生素耐药屎肠球菌和粪肠球菌的耐药率分别为82.6%和30.0%,检出1株对万古霉素耐药的屎肠球菌,未发现对利奈唑胺耐药菌株。青霉素耐药的肺炎链球菌占4.0%(6/151),肺炎链球菌对红霉素、克林霉素、四环素、复方磺胺的耐药率均高于90%。流感嗜血杆菌、副流感嗜血杆菌以及卡他布兰汉菌产β内酰胺酶的比例分别为58.1%(175/301)、70.0%(21/30)、75.9%(22/29)。肠杆菌细菌中产超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌检出率分别为59.9%和74.1%,耐药率最低的分别是3种碳青酶烯类抗生素和阿米卡星。不发酵糖G杆菌在分离病原菌中所占比例较低,为12.1%(148/1 692),主要为鲍曼不动杆菌和铜绿假单胞,药敏结果显示,除铜绿假单胞对复方磺胺耐药率为93.5%和鲍曼不动杆菌对氨曲南耐药率为38.9%外,该两种细菌对所测抗生素敏感性高,均在80%以上,未检出泛耐药细菌。结论定期进行细菌耐药性监测有助于了解医院细菌耐药性变迁,对指导医院合理应用抗菌药物有重要意义。

Objective To investigate the antibiotic resistance of clinical isolates collected from the Second Hospital of Sichuan University in 2011.Methods VITEK 2 Compact and ATBTM were used to test the susceptibility of clinical isolates to selected antimicrobial agents.Results were analyzed according to 2011 CLSI standards.The susceptibility data were analyzed by WHONET 5.4 software.Results A total of 1692 strains were isolated from various clinical specimens,of which gram negative organisms and gram positive organisms accounted for 72.0% and 28.0%,respectively.The top five were E.coli,H.influenzae,K.pneumoniae,S.pneumoniae,and S.aureus.The MRSA rate in S.aureus was 15.1%（22/146）,and the MRCNS rate in coagulase negative staphylococcus was 76.7%（46/60）.Neither vancomycin resistant strains nor linezolid resistant strains were detected.E.faecium had significantly higher antimicrobial resistance than E.faecalis,and their ampicillin resistance rates were 95.7% and 13.3%,respectively.The E.faecium and E.faecalis had a high level of aminoglycoside antibiotic resistance（HLAR） rate of 82.6% and 30.0%,respectively.One vancomycin-resistant E.faecium strain was detected,but no linezolid-resistant strains were found.Penicillin resistance S.pneumoniae（PRSP） accounted for 4.0%（6/151）,and its resistance rates to erythromycin,clindamycin,tetracycline and trimethoprim/sulfamethoxazole were all higher than 90%.There were 58.1%（175/301） H.influenzae,70.0%（21/30） H.parainfluenzae and 75.9%（22/29） B.catarrhalis which produced β-lactamase.As a member of Enterbacteriaceae spp,the prevalence of extended-spectrum β-laetamases producing strain was 59.9% of E.coli and 74.1% of K.pneumoniae.The lowest drug-resistant rates were three kinds of carbapenems and amikacin.Non fermenters gram negative organisms（NFGNB） in clinical isolates accounted for a low ratio,at 12.1%（148/1692）,and they were mainly A.baumannii and P.aeruginosa.Drug susceptibility data showed that the resistance rate of P.aeruginosa to trimethoprim/sulfamethoxazole was 93.5%,and A.baumannii to aztreonam was 38.9%.The resistance of these two kinds of bacteria to antibiotics we tested had a high sensitivity,which was above 80%.Extensively drug-resistant（XDR） bacteria was not detected.Conclusions Periodic surveillance of bacteria resistance is most important and valuable for antimicrobial therapy.