2014年中国云南地区细菌耐药监测

Bacterial resistance surveillance in Yunnan province in 2014

目的了解云南省临床分离菌对常用抗菌药的敏感性和耐药性。方法采用纸片扩散法或自动化仪器法按统一方案进行细菌药敏试验。按CLSI 2014年版标准判断药物敏感性。结果 2014年l月至12月各医院临床分离菌82548株,其中革兰阴性细菌58969株,占71.4%,革兰阳性细菌23579株,占28.6%。甲氧西林耐药金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为27.2%和78.2%,未发现万古霉素、替考拉宁和利奈唑胺耐药菌株。肠球菌属细菌中屎肠球菌对所测试的抗菌药(氯霉素和利奈唑胺除外)的耐药率均显著高于粪肠球菌,两者中均有少数万古霉素和替考拉宁耐药株,耐药率<1%。儿童株中对青霉素敏感(PSSP)、中介(PISP)和耐药(PRSP)的检出率分别为75.3%、17.3%和7.4%,成人株中分别为70.5%、27.9%和1.6%。大肠埃希菌、克雷伯菌属细菌和奇异变形菌中产超广谱β-内酰胺酶(ESBLs)株分别为55.4%、29.3%和26%。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,绝大多数菌株的耐药率低于10%。大肠埃希菌和肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为0.4%和0.3%,6.2%及5.2%,同比2013年有所增长。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别27.0%和23.3%,鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别49.1%和51.5%。结论细菌耐药性仍呈增长趋势,对碳青霉烯酶耐药的肠肝菌科细菌及鲍曼不动杆菌因引起高度重视,避免其流行播散,对临床构成严重威胁。进行流行病学调查并采取有效的控制措施,刻不容缓。

Objective To investigate the susceptibility and resistance of clinical isolates from hospitals in Yunnan province. Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were analyzed according to CLSI 2014 breakpoints. Results A total of 82,548 clinical isolates were analyzed from January to December 2014, of which Gram negative bacteria 58,969 strains, accounting for 71.4%, 23,579 strains of Gram positive bhcteria, accounting for 28.6%, resperctively. Methicillin-resistant Strains in StaphyloCoccus aureus （MRSA） and eoagulase negative staphylococci （MRCNS） accounted for 27.2% and 78.2%, respectively. No Staphylococcus strains were found resistant to vancomycin, teicoplanin and linezolid. In Enterococcus spp., the resistance rates of Enterococcus faecium strains to most tested drugs（except chloramphenicol and linezolid）were significantly higher than those of Enterococcus faecalis. Less than 1% of these strains were resistant to vancomycin. Regarding non-meningitis Streptococcus pneumoniae strains, the prevalence of PSSP, PISP and PRSP isolated from children were 75.3%, 17.3% and 7.4%, respectively. The prevalence of PSSP, PISP and PRSP isolated from adults were 70.5%, 27.9% and 1.6%, respectively. The prevalence of ESBLs producing strains were 55.4% in E.coli, 29.3% in Klebsiella pneumonia and 26% in Proteus mirablis, respectively.The strains of Enterobacteriaceae were still highly susceptible to carbapenems. Less than 10% of these strains were resistant to carbapenems. About 0.4% and 0.3% of Escherichia coli strains were resistant to imipenem and meropenem,respectively. About 6.2% and 5.2% of Klebsiella pneumoniae were resistant to imipenem and meropenem, respectively. Resistant rates showed increasing compared with the data of year 2013. About 27.0% and 23.3% of Pseudomonas aeruginosa were resistant to imipenem and meropenem, respectively. About 49.1% and 51.5% of Acinetobacter baumannii bacilli were resistant to imipenem and meropenem, respectively. Conclusions The antibiotic resistance of clinical isolates is growing. The disseminated of carbapenem resistant Enterobacteriaceae and A. baumannii in some departments poses a serious threat to the clinical. To avoid the spread, epidemiological investigation should be carried out and take effective infection control measures.