深圳市南山区人民医院2011年细菌耐药监测

Surveillance of Bacterial Resistance in Affiliated Nanshan Hospital of Shenzhen in 2011

【目的】了解本院2011年临床住院病人分离菌株对各种常用抗菌药物的耐药性，以指导临床合理用药。【方法】应用微量肉汤稀释法，检测临床分离菌对各种常用抗菌药物的耐药性，参照CLS12010版判断结果，并用wH（）NET5．4软件统计分析。[结果]2011年1～12月收集的临床住院病人分离菌共2137株，其中革兰阳性（G＋）菌占35．1％，革兰阴性（G一）菌占64，9％。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株所占的比例分别为24．1％和62．6％。葡萄球菌属中甲氧西林耐药株对p内酰胺类抗生素和其他测试药的耐药率显著高于甲氧西林敏感株，但仍有约50％～80％的菌株对四环素、复方新诺明或利福平敏感，未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对大多数测试药物的耐药率低于屎肠球菌，粪肠球菌中发现2株对利奈唑胺耐药的菌株，经使用微量肉汤稀释法鉴定后确认为耐利奈唑胺的粪肠球菌，未发现万古霉素及替考拉宁耐药株。大肠埃希菌、肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）菌株所占比例分别平均为46．6％和25．5％。肠杆菌科细菌中产ESBLs菌株对测试药物的耐药率均比非产ESBLs菌株高。肠杆菌科细菌对碳青霉烯类仍高度敏感，总耐药率小于1．0％。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为32．2％和21．9％，不动杆菌属（鲍曼不动杆菌占90．8％）对两者的耐药率均为45．4％。嗜麦芽窄食单胞菌对复方新诺明、左氧氟沙星敏感率均在80．0％以上。[结论]2011年本院分离的细菌以G-杆菌为主，细菌多重耐药性严重，利奈唑胺耐药肠球菌和碳青霉烯类抗生素耐药肺炎克雷伯菌有增多趋势，尤其G杆菌增多。鲍曼不动杆菌及铜绿假单胞菌对碳青霉烯类抗生素耐药的增加，对临床构成严重威胁。合理选用抗菌药，加强感染控制措施是当务之急，各医院采取有效控制措施刻不容缓。

[Objective] To understand the drug resistance of clinical isolates from inpatients of our hospital in 2011 in order to guide clinical rational administration. [Methods] Micro-broth dilution method was used to detect the resistance of clinical i solates to various antibacterials. According to CLS2010 edition, the results were assessed. WHONET5.4 software was used for statistical analysis. [Results]A total of 2137 isolated strains from clinical inpatients between Jan. 2011 and Dec. 2011 were collected. Among all strains, gram-positive（G＋） and gram-negative（G ） bacteria accounted for 35. 1% and 64.9%, respec- tively. Methicillin resistant strains in S. aureus and coagulase negative Staphylococcus accounted for 24. 1% and 62.6 %, re spectively. Among staphylococci, the resistance rates of methicillin resistant strains to lactams and other antimicrobial agents were markedly higher than those of methicillin sensitive strains. However, about 500/oo to 80~ of methicillin resistant strains were still susceptible to tetracycline, trimethoprim-sulfamethoxazole or rifampin. No staphylococcal strain was resistant to van comycin, teicoplanin and linezolid. The resistance rate of E. faecalis strains to most of the drugs tested was much lower than that of E. faeeium. Two strains of linezolid-resistant E. faecalis were found and identified by micro-broth dilution method. No vancomycin-resistant strain or teicoplanin-resistant strain was found. Strains of ESBLs-producing in Escherichia eoli and kleb siella pneumoniae accounted for 46.6 % and 25.5%, respectively. The resistant rate of ESBLs-producing strains in enterobacte- riaeeae to the drugs tested was higher than that of non-ESBLs producing strains. The strains of enterobacteriaceae were still highly susceptible to imipenem and meropenem, and the overall resistance rate was less than 1.0%. The resistance rates of P. aeruginosa to imipenem and meropenem were 32. 2% and 21. 9%, respectively. The resistance rates of Acinetobacter spp. （Acinetobacter baumannii） to imipenem and meropenem were all 45.4 %. The susceptibility of Stenotrophomonase maltophilia to trimethoprim-sulfamethoxazole and levofloxacin were all above 80%. [Conclusion] Most of clinical isolates collected in 2011 are gram-negative bacilli. The antimicrobial resistance of common pathogenic bacteria is serious. The prevalence of linezolid-re- sistant Enterococcus and carbapenems-resistant Klebsiella pneumoniae is increased, especially that of G bacteria is increased. The resistance of Acinetobacter haumannii and Pseudomonas aeruginosa to carbapenems is increased, which poses a serious threat to clinical practice. Rationally choosing of antibacterials and strengthening the infection control is urgent priority. Effec tive control measurement should be imminently taken by hospitals.