2002年临床常见细菌耐药性监测

Antimicrobial resistance of clinical bacteria in national surveillance network in 2002

目的 调查国家细菌耐药性监测网临床常见细菌对各种抗菌药物的耐药性现状。方法 药物敏感性试验采用纸片扩散法 ,耐药性数据分析采用WHONET5软件。结果 2 0 0 2年国家细菌耐药性监测网 8个省、市、自治区的 5 7家三级甲等医院共收集患者首次分离株 4 0 379株 ;大肠埃希菌、绿脓假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌和表皮葡萄球菌是最常见菌 ;甲氧西林耐药金黄色葡萄球菌 (MRSA)和甲氧西林耐药的凝固酶阴性的葡萄球菌 (MRCNS)对临床常用抗菌药物的耐药率明显高于甲氧西林敏感金黄色葡萄球菌 (MSSA)和甲氧西林敏感的凝固酶阴性葡萄球菌(MSCNS) ;屎肠球菌对青霉素、氨苄西林及高浓度庆大霉素和链霉素的耐药率明显高于粪肠球 ;2 4 8%的肺炎链球菌对青霉素耐药 ;肠杆菌科细菌对亚胺培南和美洛培南的耐药率最低 ;产超广谱 β内酰胺酶 (ESBLs)的大肠埃希菌和肺炎克雷伯菌株的检出率分别为 18 2 %和 2 2 6 % ;除大肠埃希菌外 ,环丙沙星和左氧氟沙星对其他肠杆菌科细菌的耐药率均低于 30 % (0～ 2 9 7% ) ;绿脓假单胞菌对亚胺培南和美洛培南的耐药率分别为 19 1%和 15 2 % ,而鲍曼不动杆菌对碳青霉烯类抗生素较敏感。结论 细菌耐药性问题是抗感染治疗的主要威胁 。

Objective To investigate the antimicrobial resistance of clinical isolates in national surveillance network,where 57 tertiary hospitals located in 8 provinces, metropolitans and municipality were involved. Methods Disc diffusion test (K-Bmethod) was used to study the antimicrobial resistance. WHONET 5 was applied foranalysis. Results In the period of study in 2002, 40 379strains were collected which were the first isolate from each patient, E. coli, P. aeruginosa, K.pneumoniae, S.aureus and S. epidermidis were the most common strains among the isolates, Resistant rates of Methicillin-resistant S. aureus (MRSA) and methicillin- resistant coagulase-negitive staphylococci (MRCNS) were higher than that of methicillin-susceptible S. aureus (MSSA) and methicillin-susceptible coagulase-negitive staphylococci (MSCNS) to antimicrobial agents commonly used in clinic; Most of E. faecalis isolates remained susceptible to penicillin and ampicillin.The resistant rate of E. faecium isolates were higher than that of E. faecalis to penicillin, ampicillin, high level gentamicin and streptomycin; Resistant rate of S. pneumoniae was 24.8% to penicillin and over 60% to macrolide antibiotics such as erythromycin and azithromycin. Most of isolates of Enterobacteriaceae were susceptible to both imipenem and meropenem. The incidences of E.coli and K. pneumoniae producing extended spectrum beta- lactamase isolates were 18.2% and 22.6%, respectively; Except for E.coli , less than 30%(6.0%～29.7%) of Enterobacteriaceae isolates were resistant to ciprofloxacin and levofloxacin; 19.1% and 15.2% of P. aeruginosa isolates were resistant to imipenem and meropenem, whereas the isolates of A. baumannii were susceptible to carbapenems. Conclusions Antimicrobial resistance of clinical isolates threatens the success of infectious disease treatment. It is very important to promote the rational use of antimicrobial agents so that resistance is minimized and take effective containment for the control of the problem.