西安地区2011年度病原菌耐药监测分析

Surveillance of drug resistance of pathogens isolated from Xi′an in 2011

目的总结西安市2011年度临床分离病原菌分布和耐药特征,为医药管理部门和临床抗菌药物合理应用提供病原菌耐药监测数据。方法常规方法培养分离医院感染病原菌,并应用半自动或全自动细菌鉴定分析仪鉴定到种,药敏试验方法按CLSI规定的标准进行,采用WHONET5.6软件进行数据统计分析。结果 2011年度共分离出病原菌12 523株,其中革兰阴性杆菌8133株占64.9%,需氧革兰阳性球菌3499株占27.9%,真菌748株占6.0%;临床分离占前5位的病原菌分别为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、鲍氏不动杆菌和肺炎克雷伯菌,分别占17.1%、14.0%、12.4%、10.7%、10.0%;耐甲氧西林金黄色葡萄球菌(MRSA)的发生率为70.0%,其对替考拉宁和利奈唑胺的耐药率分别为0.1%和0.3%,未发现耐万古霉素金黄色葡萄球菌;屎肠球菌和粪肠球菌对万古霉素耐药率分别为2.5%和3.4%,对利奈唑胺的耐药率分别为0.2%和1.1%;大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶的阳性率分别为70.0%和64.2%;大肠埃希菌对环丙沙星的耐药率已达72.0%,鲍氏不动杆菌对常用抗菌药物的耐药率均达>60.0%,对美罗培南耐药率已达70.0%,其耐药性总体上高于铜绿假单胞菌。结论医院感染病原菌耐药现象较为普遍,且耐药率仍呈逐年上升趋势,特别是MRSA、产ESBLs肠杆菌科细菌、广泛耐药非发酵菌越来越严峻,耐药监测工作任重道远。

OBJECTIVE To summarize the characteristics of the distribution and drug resistance of the clinically isolated pathogens in Xi＇an in 2011 so as to provide data for the pharmaceutics department and the reasonable clinical use of antibiotics. METHODS The isolates were cultured by routine method and were identified by the semi-automatic or automatic bacteria analysis system. Drug susceptibility testing was performed according to CLSI standards. The data were statistically analyzed by using WHONET 5. 6 soft ware. RESULTS A total of 12 523 strains of pathogens were isolated in 2011, among which there were 8133 （64.9 ~//0 ）strains of gram-negative bacilli, 3499 （27.90//oo）strains of gram-positive cocci, and 748 （6.0%）strains of fungi. Escherichiacoli, Staphylococcus aureus , Pseudornonas aeruginosa , Acinebacter baumannii , and Klebsiella pneumoniae were the top five species of the clinically isolated pathogens ,accounting for 17.1~ ,14.0~, 12.4~, 10.7~, and 10.0%, respectively~ the detection rate of MRSA was 70.0 ~, and the drug resistance rates of MRSA to teieoplanin was 0. 1 ~//0, linezolid 0.3 ~ ; no strains of vancomycin-resistant to S. aureus were found; the drug resistant rates of Enterococcus faeci- urn and Enterococcus faecalis to vancomycin were 2. linezolid were 0. 2% and 1. 1%, respectively2.5 %and 3.4 %, respectively, and the drug resistance rates to the detection rates of the ESBLs-producing E. coli andK. pneumaniae were 70.0% and 64. 2%, respectively; the drug resistance rate of E. coli to ciprofloxacin was 72.0% ~ the drug resistance rate of the A. baumannii to the commonly used antibiotics was higher than 60.0~, meropenem 70.0%, the drug resistance of the A. baumannii was generally higher than that of the P. aeruginosa. CONCLUSION The spectrum of drug resistance of the pathogens causing nosocomial infections is generally wide, and the drug resistance rates are increased year by year, especially the MRSA, ESBLs-producing Enterobacteri- aceae, and the pandrug-resistant non-fermenting bacteria. The monitoring of drug resistant is still a long way to go.