四川省细菌耐药监测网2012年0～14岁儿童细菌耐药监测数据分析

2012 annual report of Sichuan provincial antimicrobial resistant investigation net: surveillance of bacterial resistance in patients aged between 0 and 14

目的了解2012年四川省0～14岁儿童细菌感染的主要病原菌及其耐药性,为临床合理用药提供参考。方法54家四川省细菌耐药监测网成员单位对0～14岁儿童临床分离的病原菌进行常规鉴定,采用纸片扩散法(K-B法)或自动化细菌鉴定系统测定细菌的耐药性,参照美国实验室与标准化研究所(Clinical and Laboratory Standards Institute,CLSI)2012年版标准判定药敏试验结果,并用WHONET5.6软件统计分析。结果共分离出细菌16584株,其中革兰阴性菌10134株(占61.1%),革兰阳性菌6450株(占38.9%)。最常见菌种依次为大肠埃希菌、金黄色葡萄球菌、肺炎链球菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、流感嗜血杆菌和卡他布兰汉菌,分别占17.8%、14.0%、12.2%、11.4%、8.9%、8.3%、3.5%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别占18.5%和69.7%,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高于粪肠球菌,对氨苄西林的耐药率分别为88.1%和2.4%,万古霉素耐药的屎肠球菌检出率为1.0%。青霉素耐药的肺炎链球菌(PRSP)占4.3%,青霉素不敏感的肺炎链球菌(PNSP)占16.8%,化脓性链球菌对青霉素、头孢噻肟、万古霉素高度敏感,对大环内酯类药物耐药率>60%。流感嗜血杆菌对氨苄西林的耐药率高达67.4%,大肠埃希菌和肺炎克雷伯菌产超光谱β内酰胺酶(ESBLs)检出率分别为58.6%和55.7%,肠杆菌科细菌对亚胺培南、美洛培南、阿米卡星仍保持较高敏感性,铜绿假单胞对多数抗菌药物耐药率<15%,鲍曼不动杆菌对常用抗菌药物的耐药率在30%左右,多重耐药或泛耐药菌株少见。结论儿童细菌感染患者中分离的主要病原菌有其特点,细菌的耐药形势严峻,加强地区细菌耐药性监测有助于指导临床合理应用抗菌药物,延缓细菌耐药产生。

Objective To investigate the distribution and antibiotic resistance of common pathogens isolated from patients aged less than 14 years in Sicbuan provincial in 2012. Methods The bacterial isolates from patients under 14 years old in 54 member hospi-tals of Sichuan Provincial of Antimicrobial Resistant Investigation Net were collected. Antimicrobial susceptibility testing was carried out by using K-B method or automatic microbiological examine systems. The results were judged according the standards（ 2012 edition）of Clinical and Laboratory Standards Institute（CLSI） ,and analyzed by using WHONET 5.6 software. Results A total of 16,584 strains were isolated from various clinical specimens, in which gram-negative organisms and gram-positive organisms were accounted for 61.1% and 38. 9% ,respectively. The most common isolates were E. coli（ 17. 8% ） ,S. aureus（ 14. 0% ） ,S. pneumoniae（ 12. 2% ） ,K. pnenmoniae（ 11.4% ）and coagulase negative Staphylococcus（MRCNS） （8.9%）. The rates of MRSA were 18.5% and MRCNS were 69. 7% ,respectively. Neither vancomycin resistant strains nor linezolid resistant strains were found. E. faecium had significantly higher antimicrobial resistance than E. faecalis ,and ampicillin resistant rates were 88. 1% and 2.4% ,respectively. One vancomycin-resistant E. faecium was found. The prevalence of penicillin non-susceptible S. pneumoniae （PNSP）in non-meningitis isolates was 16. 8%. Streptococcus pyogenes were susceptible to penicillin, eefotoxime, vancomycin, but the rate of resistant to maerolides was higher than 60%. There was 67.4% of H. influenzae ,which produced β-1actamase. The prevalence of Escherichia coli and Klebsiella pneumoniae producing ESBLsu were 58. 6% and 55.7% , respectively. Imipenem, meropenem and amikacin were the most potent antimierobial a-gents against Enterbacteriaceae. The resistant rates of P. aeruginosa to the most potent antimicrobial agents were less than 15%. The rates of resistant A. baumannii to imipenem were 28. 6% ,while extensively drug-resistant（XDR） bacteria were seldom found. Conclu-sion Periodic surveillance of bacteria resistance is very important and valuable for antimierobial therapy.