耐甲氧西林葡萄球菌及产超广谱β-内酰胺酶细菌流行状况及耐药性分析

Prevalence and drug resistance of methicillin-resistant Staphylococciand extended spectrum β-lactamases-producing bacteria

目的调查耐甲氧西林葡萄球菌及产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的流行状况及耐药性,为临床提供诊疗依据。方法对2011年3月-2012年5月所有病原菌进行鉴定及药敏试验,按CLSI 2010年推荐方法对葡萄球菌属进行耐甲氧西林检测,大肠埃希菌和肺炎克雷伯菌进行ESBLs检测。结果检出金黄色葡萄球菌342株、凝固酶阴性葡萄球菌254株,耐甲氧西林检出率分别为38.3%、69.7%,耐甲氧西林菌株对利奈唑胺、替考拉宁、万古霉素100.0%敏感,对喹奴普汀/达福普汀、莫西沙星、呋喃妥因的耐药率<20.0%,对其他药物耐药性高;916株大肠埃希菌和514株肺炎克雷伯菌ESBLs检出率分别为59.0%、34.8%,产ESBLs菌株对碳青霉烯类、阿米卡星及部分β-内酰胺酶抑制剂复合剂类敏感性较高,对其他药物耐药性高;外科、内科、ICU是各种耐药菌株流行的重要病区。结论耐甲氧西林葡萄球菌、产ESBLs大肠埃希菌和肺炎克雷伯菌发生率高,耐药严重,及时监测耐药菌株的流行状况及耐药性指导临床诊疗行为,有效预防控制医院感染。

OBJECTIVE To investigate the prevalence status and drug resistance of methicillin-resistant Staphylococci （MRS） and extended spectrum β-lactamase（ESBL）-producing E. coli and K. pneumoniae so as to provide basis for the clinical diagnosis and treatment. METHODS The identification and the drug susceptibility testing for all the pathogens isolated from Mar 2011 to May 2012 were preformed, the methieillin-resistant Staphylococci strains as well as the ESBLs-produeing E. coli and K. pneumoniae were detected according to the methods recommended by CLSI 2010. RESULTS There were 342 strains of S. aureus and 254 strains of coagulase-negative Staphylococci, the detection rates of the methicillin-resistant strains were 38.3H and 69.7%, respectively. The drug susceptibility rates of the methicillin-resistant strains to linezolid, teieoplanin, and vancomycin were 100. 0%, and the drug resistance rates to quinupristin-dalfopristin, moxifloxacin, and furantoin were less than 20. 0%, more higher to other antibiotics. The detection rate of the ESBL-producing E. coli and K. pnuemoniae were 59.0% （916 strains） and 34. 8% （514 strains）, respectively. The ESBL-producing strains were highly sensitive to carbapenems, amikacin and some of theβ-lactamase inhibitor complexer and were highly resistant to other antibiotics. The drug resistant strains were most prevalent in the surgery department, internal department and ICU. CONCLUSION The positive rates of the methicillin-resistant Staphylococci, the ESBL-produeing E. coli and K. pneumoniae are high, and the strains are highly drug resistant; it is an effective way to control the nosocomial infections by monitoring the prevalence and drug resistance of the strains in a timely manner.