2013年江苏地区12家医院细菌耐药监测结果评价

Assessment on monitoring for antimicrobial resistance of bacteria in 12 hospitals of Jiangsu province,China,2013

目的监测评价2013年江苏地区12家医院细菌耐药情况。方法收集12家医院2013年全年临床分离菌的信息,用WHONET 5.6软件进行统计分析,细菌计数剔除同一患者重复分离的相同菌株,药物敏感性的判读选用软件自带的美国临床和实验室标准化协会（CLSI）2013年版标准。结果收集12家医院2013年1-12月临床分离细菌60 505株,其中革兰阳性菌20 251株（占33.5%）,革兰阴性菌40 254株（占66.5%）。葡萄球菌中耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为54.5%和83.4%;肠球菌属中万古霉素耐药的屎肠球菌占5.4%、粪肠球菌占1%;革兰阴性杆菌中肠杆菌科细菌占59.4%,非发酵菌占39.0%。肠杆菌科细菌对第三代头孢菌素的耐药率在33.2%-56.8%之间,对碳青霉烯类抗菌药物耐药率在6.1%-8.4%之间。非发酵菌中铜绿假单胞菌占41.3%,鲍曼不动杆菌占37.7%。其中铜绿假单胞菌对亚胺培南和美罗培南的耐药率为30.9%和27.4%,鲍曼不动杆菌对亚胺培南和美罗培南的耐药率为64.0%和66.4%。结论与2012年比较,2013年江苏地区细菌耐药性仍很严重。耐甲氧西林金黄色葡萄球菌、多重耐药的鲍曼不动杆菌和多重耐药的铜绿假单胞菌的分离率略有降低;但耐甲氧西林凝固酶阴性葡萄球菌、万古霉素耐药的屎肠球菌和碳青霉烯类耐药的肠杆菌科细菌的分离率均高于2012年。

Objective To assess the monitoring for antimicrobial resistance of bacteria in 12 hospitals of Jiangsu province during the year of 2013. Methods The non-repetitive data of antimicrobial susceptibility test from twelve hospitals during 2013 were collected to the central hospital and analyzed by WHONET 5.6 software. The results were interpreted by the Criteria published by the Clinical and Laboratory Standards Institute（ CLSI 2013）. Results A total of 60 505 non-repetitive messages of bacteria were collected from the 12 hospitals. Among them, 20 251 gram-positive strains, accounting for 33.5%, and 40 254 gram-negative strains, accounting for 66.5%, were included. Among the strains of Staphylococcus, the average prevalence of methicillin-resistant strains in S. aureus （MRSA） was 54.5% and coagulase-negative Staphylococcus （MRCNS） was 83.4%. In Enterococcus spp., vancomycin-resistant E. faecium was 5.4% and E. faecalis was 1% respectively. Among the strains of gram-negative bacilli, Enterobacteriaceae bacilli accounted for 59.4% and non-fermentative bacterial added up to 39%. The resistant rates of the Enterobacteriaceae strains to the third generation of cephalosporin were from 33.2% to 56.8%, and the strains of earbapenems resistant Enterobacteriaceae（CRE） were from 6.1% to 8.4%. Among the non-fermentative bacillus, Pseudomonas aeruginosa accounted for 41.3% and Acinetobacter baumannii added up to 37.7%. The resistant rates of Pseudomonas aeruginosa to imipenem was 30.9% and meropenem was 27.4% , while the resistant rate of Acinetobacter baumannii to imipenem was 64.0% and meropenem was 66.4% respectively. Conclusions Comparing with that of 2012, the bacterial drug-resistance was still serious issue in the clinical setting of Jiangsu province in the year of 2013. The prevalences of MRSA, multiple drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa slightly reduced, but the preva- lences of MRCNS, vaneomycin-resistant Enterococcusfaecium and CRE were higher than those in the year of 2012.