2009—2011年辽宁省某医院革兰阳性菌耐药性监测结果分析

Drug Resistance of Gram- positive Bacteria in A Hospital of Liaoning Province from 2009 to 2011

目的了解辽宁医学院附属第一医院2009—2011年3年间临床分离的革兰阳性菌株的分布及耐药情况,指导临床合理使用抗菌药物。方法对所分离的革兰阳性菌株采用最低抑菌浓度(MIC)法进行药敏试验,按美国临床实验室标准化研究所(CLSI)2011年标准判定药敏试验结果,并用WHONET 5.6软件进行数据分析。结果共分离出非重复革兰阳性菌718株,其中葡萄球菌属495株(占68.94%),肠球菌属212株(占29.53%),链球菌属11株(占1.53%)。革兰阳性菌的检出部位来自尿液187株(占26.04%)、痰液164株(占22.84%)、创口分泌物113株(占15.74%)、血液78株(占10.86%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为33.3%(51/153)和84.7%(288/340),未发现对万古霉素耐药的葡萄球菌属;未发现对哌拉西林/他唑巴坦及阿莫西林/克拉维酸耐药的屎肠球菌;万古霉素耐药肠球菌(VRE)分离率仍很低,粪肠球菌和屎肠球菌分别为5.0%(5/101)和5.1%(5/99);屎肠球菌对多数药物的耐药率均高于粪肠球菌。结论革兰阳性菌耐药形势严峻,应重视细菌耐药性监测及抗菌药物的合理使用。

Objective To investigate the distribution and the antimicrobial resistance of Gram- positive bacteria in the First Hospital Affiliated to Liaoning Medical University in China from 2009 to 2011. Methods Antimicrobial susceptibility testing were carried out in the strains of Gram- positive bacteria with minimum inhibitory concentration( MIC) and the data were analyzed by WHONET 5. 6 software according to CLSI 2011 Standards. Results A total of 718 clinical isolates of Gram- positive bacteria were collected including 495 strains of Staphylococci( 68. 94%),212 strains of Enterococci( 29. 53%),and 11 strains of Streptococci( 1. 53%). Among all 718 strains of Gram- positive bacteria,26. 04%( 187 /718) were isolated from urine specimens,22. 84%( 164 /718) from sputum specimens,15. 74%( 113 /718) from wound secretion,and 10. 86%( 78 / 718) from blood specimens. The prevalence of Methicillin- resistant S. aureus( MRSA) and Methicillin- resistant coagulase-negative S. aureus( MRCNS) were 33. 3%( 51 /153) and 84. 7%( 288 /340),respectively. There were no Staphylococcus strains resistant to vancomycin and no Enterococcus strains resistant to piperacillin / tazobactam or Amoxicillin / clavulanic acid. The resistance rates of Enterococci to vacomycin were very low,the its rates in E. faecalis and E. faecium were 5. 0%( 5 /101) and 5. 1%( 5 /99),respectively. The resistance rates of E. faecium strains to most tested drugs were higher than those of E. faecalis. Conclusion The antimicrobial resistance rates of Gram- positive bacteria are high,which has been a big challenge for healthcare management. We should pay more attention to monitoring the drug resistance of these bacteria and enhancing the rational use of antibiotics.