2005-2015年上海交通大学医学院附属仁济医院细菌耐药性监测

Surveillance of bacterial resistance in Shanghai Renji Hospital during the period from 2005 to 2015

目的了解2005-2015年上海交通大学医学院附属仁济医院临床分离菌株对常用抗菌药物的耐药性。方法药敏试验采用纸片扩散法,按CLSI 2015年版标准判读结果。结果 55 155株非重复菌株中革兰阳性菌占35.8%,革兰阴性菌占64.2%。分离居前5位分别是大肠埃希菌(15.0%)、铜绿假单胞菌(14.0%)、鲍曼不动杆菌(11.9%)、肺炎克雷伯菌(11.8%)和金黄色葡萄球菌(10.2%)。甲氧西林耐药金黄色葡萄球菌和凝固酶阴性葡萄球菌平均检出率分别为70.2%(3 967/5 650)和83.2%(4 997/6 004)。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。共检出耐万古霉素肠球菌15株。大肠埃希菌、克雷伯菌属细菌和奇异变形杆菌产ESBL株平均检出率分别为70.4%(5 843/8 300)、53.5%(3 500/6 539)和44.1%(557/1 263)。2012年首次检出耐碳青霉烯类肺炎克雷伯菌,检出率为0.6%(4/656),2015年升至30.1%(142/472)。2015年耐碳青霉烯类大肠埃希菌检出率为2.0%(16/787),其余年份几乎为0。广泛耐药鲍曼不动杆菌和铜绿假单胞菌平均检出率分别为39.1%(2 566/6 556)和4.0%(308/7 704)。189株产气肠杆菌中共检出9株广泛耐药株。结论 2005-2015年该院细菌对抗菌药物的耐药率仍呈上升趋势,成为临床治疗的一大挑战,多重耐药及广泛耐药菌株增多使临床治疗尤为棘手。

Objective To investigate the antimicrobial resistance of clinical isolates from Renji Hospital, Shanghai Jiao Tong University School of Medicine during the period from 2005 to 2015. Methods Antimicrobial susceptibility testing was carried out according to Kirby-Bauer method. Results were analyzed according to CLSI 2015 breakpoints. Results A total of 55 155 nonduplicate clinical isolates were collected from 2005 to 2015. The top 5 most frequently isolated bacterial species were E. coli （15.0%）, P. aeruginosa （14.0%）, A. baumannii （11.9%）, K. pneumoniae （11.8%） and S. aureus （10.2%）. Gram positive cocci and gram negative organisms accounted for 35.8% and 64.2%, respectively. The prevalence of methicillin-resistant strains in S. aureus （MRSA） and coagulase negative Staphylococcus （MRCNS） was 70.2% （3 967/5 650） and 83.2% （4 997/6 004）. No staphylococcal strain was resistant to vancomycin, teicoplanin or linezolid. Fifteen strains of Enterococcus were found resistant to vancomycin. Theaverage prevalence of ESBLs-producing strains was 70.4% （5 843/8 300） in E. coli, 53.5% （3 500/6 539） in Klebsiella spp. and 44.1% （557/1 263） in P. mirabilis. A few carbapenemase- producing K. pneumoniae strains were identified for the first time in 2012 with the prevalence of 0.6% （4/656）, and the prevalence hit high （30.1%, 142/472） in 2015. The prevalence of carbapenemase-producing E. coli was 2.0% （16/787） in2015, and almost zero in the other years. The prevalence of extensively drug-resistant A. baumannii and P. aeruginosa was 39. 1% （2 566/6 556） and 4.0% （308/7 704）, respectively. Extensively drug-resistant strain was identified in 9 of the strains of 189 E. aerogenes isolates. Conclusions Bacterial resistance is still on the rise, which poses a major challenge to clinical antimicrobial therapy, especially the multi-drug resistant and extensively drug resistant bacteria.