2009年上海地区细菌耐药性监测  

Surveillance report of bacterial resistance from hospitals in Shanghai in 2009

作　　者：朱德妹[1] 张婴元[1] 汪复[1] 郭燕[1] 蒋晓飞[1] 倪语星[2] 孙景勇[2] 应春妹[3] 汪雅萍[3] 王传清[4] 王爱敏[4] 蒋燕群[5] 汤瑾[5] 张泓 李万华 沈燕雅[7] 金文敏[7] 周庭银[8] 陈险峰[8] 张蓓[9] 黄卫春[9] 杨海慧[10] 卫颖珏[10] 汤荣 丁星 吴丽桂[12] 武楠[12] 汪瑞忠[13] 房华[13] 吕新华[14] 朱爱英[14] 

机构地区：[1]复旦大学附属华山医院,上海200040 [2]上海交通大学医学院附属瑞金医院 [3]上海交通大学医学院附属仁济医院,浦东 [4]复旦大学附属儿科医院 [5]上海交通大学附属第六人民医院 [6]上海交通大学附属儿童医院 [7]上海市第二人民医院 [8]第二军医大学附属长征医院 [9]上海交通大学医学院附属儿童医学中心[10]上海交通大学医学院附属仁济医院,浦西 [11]上海交通大学附属第一人民医院 [12]复旦大学附属金山医院 [13]上海浦东新区人民医院 [14]解放军第455医院

出　　处：《中国感染与化疗杂志》2010年第6期403-413,共11页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解上海地区2009年14所医院临床分离株的耐药情况。方法采用纸片扩散法(K-B法)对临床分离株进行药敏试验。采用CLSI2009年版判断标准。结果 37167株细菌中革兰阳性菌占30.0%,革兰阴性菌占70.0%。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为56.5%和72.2%。未发现万古霉素、替考拉宁和利奈唑胺耐药株。671株肺炎链球菌中5株为脑膜炎患儿分离的肺炎链球菌,称为儿童株。非脑膜炎儿童患者分离的617株肺炎链球菌中青霉素敏感肺炎链球菌(PSSP)的检出率为68.4%(422/617),青霉素不敏感株(PISP和PRSP)的检出率分别为17.0%(105/617)和14.6%(90/617)。49株成人患者非脑膜炎肺炎链球菌均为PSSP,无青霉素不敏感株。发现7株万古霉素耐药屎肠球菌和1株粪肠球菌,前者均为vanA型耐药,后者为vanB型耐药。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌+产酸克雷伯菌)和奇异变形杆菌中产ESBLs的检出率分别为60.2%、46.4%和15.4%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为24.5%和17.9%。不动杆菌属(含90.4%鲍曼不动杆菌)对亚胺培南和美罗培南的耐药率分别为37.8%和40.5%。新出现少数大肠埃希菌(0.04%,3/7049)和肠杆菌属细菌(0.3%,4/1459)的泛耐药株。泛耐药鲍曼不动杆菌的检出率(14.2%,505/3567)较2008年(5.9%,180/3069)明显上升。结论细菌耐药性仍呈增长趋势,新出现少数泛耐药肠杆菌科细菌,泛耐药鲍曼不动杆菌较往年又有较显著的增加。加强对泛耐药菌株的流行病学和耐药机制的研究,并采取积极有效的防控措施为当务之急。Objective To investigate the resistance of clinical isolates in Shanghai hospitals from January to December in 2009.Methods Antimicrobial susceptibility testing of 37 167 clinical isolates were carried out according to a unified protocol using Kirby-Bauer(KB).Results were analyzed according to CLSI 2009 breakpoints.Results Of the 37 167 clinical isolates,gram negative bacilli and gram positive cocci accounted for 70% and 30%,respectively.The pre-valence of MRSA in S.aureus was 56.5%.The prevalence of MRCNS in coagulase negative Staphylococcus was 72.2%.No strain was found resistant to vancomycin,teicoplanin or linezolid.Five meningitis strains(all from children)were identified in 851 strains of S.pneumoniae.The prevalence of penicillin-susceptible S.pneumoniae(PSSP)was 68.4% in 617 nonmeningitis strains from children.Penicillin-nonsusceptible S.pneumoniae(PISP + PRSP)strains accounted for 31.6%(PISP 17.0% and PRSP 14.6%).The nonmeningitis strains from adults were all PSSP.Eight VRE strains were found in Enterococcus spp,including 7 strains of E.faecium(vanA type),1 strain of E.faecalis(vanB type).ESBLs-producing strains accounted for 60.2%,46.4% and 15.4% in E.coli,Klebsiella spp(K.pneumoniae + K.oxytoca)and P.mirabilis,respectively.The resistance rates of P.aeruginosa to imipenem and meropenem were 24.5% and 17.9% respectively.And 37.8% and 40.5% of Acinetobacter spp strains were resistant to imipenem and meropenem.A few pan-resistant strains of Enterobacteriaceae were identified,including E.coli(0.04%,3/7 049)and Enterobacter spp.(0.3%,4/1 459).The prevalence of pan-resistant strains in A.baumannii(14.2%,505/3 567)was significantly higher than that in 2008(5.9%,180/3 069).Conclusions Bacterial resistance is still on the rise.A few pan-resistant Enterobacteriaceae strains have emerged.Especially the pan-resistant A.baumannii has increased significantly.It is urgently needed to strengthen the epidemiology and mechanism study of antibiotic resistance and take effective control measures.

关 键 词：细菌耐药性 抗菌药 药敏试验 泛耐药菌 

分 类 号：R446.5[医药卫生—诊断学]