2012年湖北省成人患者血培养分离菌耐药性分析

Antimicrobial susceptibility of bacterial isolates from blood of adult patients in Hubei Province during 2012

目的了解湖北省成人患者血培养常见病原菌分布及耐药性情况。方法对湖北省细菌耐药性监测网2012年1—12月所有成人患者血液标本按常规方法进行细菌分离培养和鉴定。按统一方案用纸片扩散法进行抗菌药物敏感性试验。结果成人患者血培养共分离病原菌3 833株,其中最常见的病原菌依次为大肠埃希菌（25.9%）、凝固酶阴性葡萄球菌（24.0%）、金黄色葡萄球菌（金葡菌）（11.8%）、克雷伯菌属（8.1%）和肠球菌属（5.4%）。大肠埃希菌和克雷伯菌属产超广谱β内酰胺酶（ESBL）菌株的检出率分别为67.1%和85.9%。药敏结果显示：大肠埃希菌对哌拉西林-他唑巴坦、头孢西丁、亚胺培南、美罗培南和阿米卡星敏感率高（〉80.0%）,克雷伯菌属对头孢哌酮-舒巴坦、哌拉西林-他唑巴坦、头孢西丁、亚胺培南、美罗培南、阿米卡星和左氧氟沙星敏感率高（〉80.0%）。肠杆菌科细菌对碳青霉烯类药物的耐药率在0-25.0%。耐甲氧西林金葡菌（MRSA）和凝固酶阴性葡萄球菌（MRCNS）检出率分别为41.8%和55.7%。未发现对万古霉素、替考拉宁和利奈唑胺不敏感株。MRSA对氯霉素耐药率低（〈30.0%）,MRCNS对利福平耐药率低（〈15.0%）,甲氧西林敏感葡萄球菌对青霉素和红霉素耐药率较高（〉50.0%）,对其他常用抗菌药物耐药率均较低。屎肠球菌耐万古霉素的检出率为3.4%。肺炎链球菌中青霉素敏感、中介和耐药菌株的检出率分别为57.6%、28.8%和13.6%。肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌中有少量菌株为广泛耐药菌株（除替加环素和多黏菌素外对所有常用抗菌药物均耐药）。结论大肠埃希菌和金葡菌是成人血培养最常见的病原菌,其对不同种类抗菌药物耐药性不同,临床医师应该根据药敏结果合理选用抗菌药物,防止耐药菌株的传播。

Objective To investigate the distribution and antimicrobial susceptibility of microbial strains isolated from blood of adult patients in Hubei Province.Methods The microbial isolates from blood samples were identified routinely from January to December in 2012.Antimicrobial susceptibility of these isolates were tested by Kirby-Bauer method.Results The top strains were E.coli（25.9%）,coagulase-negative Staphylococcus（CNS）（24.0%）,S.aureus（11.8%）,Klebsiellaspp.（8.1%）,and Enterococcus spp.（5.4%）.The overall prevalence of ESBLs-producing strains was 67.1% in E.coli and 85.9% in Klebsiella spp.respectively.E.coli strains were highly susceptible to piperacillin-tazobactam,cefoxitin,imipenem,meropenem and amikacin.More than 80.0% of the strains were susceptible to these antibiotics.K.pneumoniaeisolates were highly susceptible to cefoperazone-sulbactam,piperacillin-tazobactam,cefoxitin,imipenem, meropenem,amikacin and levofloxacin.More than 80.0% of the strains were susceptible.Overall,less than 25.0% of Enterobacteriaceaeisolates were resistant to carbapenem antibiotics.The overall prevalence of methicillin-resistant Staphylococcus strains was 41.8%in S.aureus and55.7%in CNS,respectively.No strains were found resistant to vancomycin,teicoplanin or linezolid.Methicillin-resistant S.aureus（MRSA）strains showed lower resistance rate（30.0 %）to chloramphenicol.Less than 15.0 % of MRCNS were resistant to rifampin.MSSA and MSCNS strains were highly resistant to penicillin and erythromycin（〉50.0% resistant）,but not to the other antimicrobial agents.About 3.4% of E.faecium strains were resistant to vancomycin.Of the 59 strains of non-meningitis S.pneumoniae,57.6% were penicillin-susceptible（PSSP）,28.8% penicillin-intermediate（PISP）and 13.6% penicillin-resistant（PRSP）.A few pan-drug resistant strains were identified in K.pneumoniae,P.aeruginosa and A.baumannii.Conclusions E.coli and S.aureus are the most frequent pathogens isolated from blood of adult patients in Hubei Province.They showed different resistance to different kinds of antimicrobial agents.Antibiotics should be prescribed cautiously and reasonably according to the results of susceptibility testing,which is helpful for preventing the spread of resistant strains.