2011年度海口市人民医院细菌耐药性监测

Surveillance of bacterial resistance from a hospital in Haikou city in 2011

目的分析海口市人民医院2011年临床分离细菌对抗菌药物的耐药性。方法采用纸片扩散法(K-B法)对2011年度临床分离菌株进行药敏试验,结果按CLSI 2011年版标准判读,用Whonet 5.6软件进行耐药性分析。结果 2011年共收集非重复临床分离菌株3 978株,其中革兰阴性菌占79.2%(3 150/3 978),革兰阳性菌占20.8%(828/3 978)。MRSA和MRCNS检出率分别为36.3%和81.7%,未发现对万古霉素和利奈唑胺耐药的葡萄球菌。检出万古霉素耐药的粪肠球菌3株和屎肠球菌1株,未发现利奈唑胺耐药株。肺炎链球菌中青霉素耐药株(PRSP)占16.0%。β溶血链球菌对万古霉素、青霉素、氨苄西林和左氧氟沙星均高度敏感。大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌中ESBLs阳性率分别为69.8%、47.8%和25.4%,发现对亚胺培南和美罗培南耐药的大肠埃希菌9株和肺炎克雷伯菌9株。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为27.4%和21.1%。鲍曼不动杆菌对11种抗生素的耐药率均在30%以下。左氧氟沙星和复方新诺明对嗜麦芽窄食单胞菌有较好的抗菌活性(耐药率<10%)。结论 2011年该院分离的细菌以革兰阴性杆菌为主,临床分离细菌对常用抗菌药物呈不同程度的耐药,检出对万古霉素耐药的肠球菌和对碳青霉烯类抗生素耐药的肠杆菌科细菌,应引起重视。

【Objective】 To investigate the resistance of clinical isolates from a hospital in Haikou city in 2011.【Methods】 Antimicrobial susceptibility testing was carried out by Kir by-Bauer（KB） method and the data were analyzed by WHONET 5.6 software according to CLSI 2011 breakpoints.【Results】 Of the 3 978 clinical isolates,gram-negative bacilli and gram-positive bacilli accounted for 79.2%（3 150 / 3 978） and 20.8%（828 / 3 978）,respectively.The detection rate of the meticillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus was 36.3% and 81.7%.No vancomycin or linezolid resistant isolate was found in Staphylococcus.Three Enterococcus faecalis and one Enterococcus faecium isolates were found resistant to vancomycin.No linezolid resistant isolate was found in Enterococcus.The resistant rate of Streptococcus pneumoniae to penicillin was 16%.Beta-hemolytic Streptococcus was highly sensitive to vancomycin,penicillin, ampicillin and Levofloxacin.ESBLs-producing E.coli,K.pneumoniae and P.mirabilis were accounted for 69.8%,47.8% and 25.4%.9 Escherichia coli and 9 K.peumoniae isolates were resistant to imipenem and meropenem.The resistant rates of Pseudomonas aeruginosa to imipenem and meropenem were 21.1% and 27.4%,respectively.The drug resistant rates of Acinetobacter baumannii to 11 antibiotics were below 30.0%. Stenotrophomonas maltophilia was sensitive to levofloxacin medicine and trimethoprim Sulfamethoxazole（drugresistant rate 10%）.【Conclusion】 The surveillance results have showed gram-negative bacilli being the most common isolates in our hospital during 2011.Vancomycin-resistant isolates in Enterococci and carbopenems-resistant isolates in Enterobacteriaceae have been detected in our surveillance,which should be noted.