四川省细菌耐药监测网2012年川西地区细菌耐药性监测分析

2012 annual report of Sichuan provincial antimicrobial resistant investigation net: bacterial drug resistance surveillance in the west Sichuan

目的总结分析川西地区4个市(州)20家医院2012年度临床分离病原菌的分布及对抗菌药物的耐药性,掌握本地区病原菌及其耐药的变化趋势。方法采用K-B法或自动化仪器分析法对临床分离细菌进行药物敏感试验,依据美国实验室与标准化研究所(Clincal and Laboratory Standards Institute,CLSI)2012年标准,采用WHO-NET5.6软件进行统计分析。结果川西地区4个市(州)20家医院共分离出病原菌株37859株,其中革兰阴性菌27717株,占分离菌的73.21%;革兰阳性菌10142株,占分离菌的26.78%。分离菌中前10位病原菌依次为大肠埃希菌(6661株)、肺炎克雷伯菌(4076株)、金黄色葡萄球菌(3287株)、鲍曼不动杆菌(3197株)、铜绿假单胞菌(3100株)、凝固酶阴性葡萄球菌(2904株)、肺炎链球菌(1873株)、流感嗜血杆菌(1489株)、阴沟肠杆菌(1151株)、屎肠球菌(897株)。肠杆菌科细菌对碳青酶烯类仍保持较高的敏感率(>94.6%)。未检测到万古霉素及利奈唑胺耐药的葡萄球菌,粪肠球菌对替考拉宁和万古霉素耐药率分别为0.8%和0.7%,屎肠球菌对二者的耐药率分别为4.9%和6.6%。结论产超光谱β内酰胺酶的发酵菌及多重耐药的铜绿假单胞菌和鲍曼不动杆菌呈逐年上升趋势;耐甲氧西林葡萄球菌(MRS)比例有下降趋势,MRS和耐糖肽类的肠球菌仍是抗菌药物治疗中的难点。临床应根据细菌的耐药表型和药敏试验结果合理选用抗菌药物。

Objective To summarize the distribution of pathogenic bacteria and drug resistance to antimicrobial agents in clin-ical isolates collected from 20 hospitals in the western Sichuan in 2012 in order to master the change trend in the region. Methods I-solates were cultured by routine method and identified by the semi-automatic or automatic bacteria analysis system. Drug susceptibility testing was performed according to CLSI standards. Data were statistically analyzed by using WHONETS. 4 software. Results A total of 37,859 pathogenic strains were isolated including 27,717 gram negative bacteria strains（73.21% ）and 10,142 gram positive bacteria （ 26. 78 % ）. The top ten pathogens were E. Coli （ 6661 ）, K. Pneumonia （ 4076 ）, S. aureus （ 3287 ）, A. Baumannii （ 3197 ）, P. Aeruginosa （ 3100 ）, S. Epidermidis （ 2904 ）, S. Pne （ 1873 ）, H. Influ （ 1489 ）, E. Faecalis （ 1151 ） and E. Faecium （ 897 ）. The sensitive rate of Enter-obacteriaeeae remained high to carbapenems. The drug resistant rates of Enterococcus Faecalis to teicoplanin and vaneomycin were 0. 8% and 0.70% ,respectively. Enterococeus Faecium was 4. 9% and 6. 6%. Conclusion Ratios of ESBLs-producing Enterobacteri-aceae and multiple drug-resistant Pseudomonas Aeruginosa and Acinetobacter Baumannii are increased year by year while the propor-tion of methicillin-resistant Staphylococcus aureus（MRSA） is decreased. MRS and glycopeptides resistant Enterococcus are still a diffi-cult problem for treatment. Therefore, reasonable choice of antimicrobial agents should be based on the detection of bacterial resistant drug phenotype and results of drug susceptibility testing.