2005-2014年上海交通大学医学院附属瑞金医院细菌耐药性监测

Report of bacterial resistance surveillance in Shanghai Ruijin Hospital from 2005 to 2014

目的了解上海端金医院最近10年临床分离菌对常用抗菌药物的敏感性和耐药性。方法采用纸片扩散法按统ー方案进行药物敏感性试验。按CLSI 2014年版标准判断結果。结果10年共收集临床分离菌44 744株,其中革兰阳性菌14 066株,占31.4%,革兰阴性菌30 678株,占68.6%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)的平均检出率分别为62.9%和74.7%。MRSA和MRCNS对β内酰胺类抗生素和其他测试药物的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。MRSA中有70.3%的菌株对甲氧苄啶-磺胺甲噁唑敏感;MRCNS中有90.8%的菌株对利福平敏感。肠球菌属中粪肠球菌对绝大多数所测试抗菌药物(替考拉宁除外)的耐药率均显著低于屎肠球菌。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率≤6.5%。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为52.0%和52.3%。结论细菌耐药率仍呈局部增长趋势,多重耐药和广泛耐药菌株对临床构成严重威胁,应进行流行病学调查并采取有效的感控措施。

Objective To investigate the susceptibility and resistance profile of clinical isolates collected from Shanghai Ruijin Hospital in recent ten years.Methods Clinical isolates were collected from Shanghai Ruijin Hospital during the period from2005 to 2014 and were tested for susceptibility to antimicrobial agents using Kirby-Bauer method or automated systems according to a unified protocol.Results were analyzed according to CLSI 2014 breakpoints.Results A total of 44 744 clinical isolates were collected,of which gram negative organisms and gram positive cocci accounted for 68.6%（30 678/44 744） and 31.4%（14 066/44 744）,respectively.Methicillin-resistant strains in S.aureus（MRSA） and coagulase negative Staphylococcus（MRCNS）accounted for an average of 62.9%and 74.7%,respectively.The resistance rates of methicillin-resistant strains to P-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains.However,70.3% of the MRSA strains were still susceptible to trimethoprim-sulfamethoxazole while 90.8% of the MRCNS strains were susceptible to rifampin.In Enterococcus spp.,the resistance rates of E.faecalis strains to most of the antibiotics tested（except teicoplanin） were much lower than those of E.faecium.The strains of Enterobacteriaceae were still highly susceptible to carbapenems.Overall,not more than 6.5% of these strains were resistant to carbapenems.About 52.0% and 52.3% ot A.baumannii strains were resistant to imipenem and meropenem,respectively.Conclusions The antibiotic resistance is growing in local clinical bacterial isolates.The emerging multi-drug resistant and pandrug-resistant strains in a specific region poses serious threat to clinical practice and implies the importance of strengthening infection control.