1998~2004年临床分离病原菌的耐药性变迁  

Variation of drug resistance of pathogens isolaged from 1998 to 2004

作　　者：侯晓娜[1] 杨婧[1] 万楠[1] 刘珊[1] 何莉[1] 丁雪松[1] 傅炜昕[1] 

机构地区：[1]沈阳军区总医院检验科,辽宁沈阳110016

出　　处：《中国实验诊断学》2006年第3期238-242,共5页Chinese Journal of Laboratory Diagnosis

摘　　要：目的监测临床病原菌的耐药性变迁。方法统计1998年1月-2004年12月临床送检标本中分离的病原菌及药敏结果，不计重复株。细菌分离鉴定按卫生部临检中心颁布的《全国临床检验操作规程》第二版进行。药敏采用纸片扩散法，结果判定根据NCCLS判断标准，耐甲氧西林葡萄球菌（MRS）采用苯唑西林纸片扩散法，产超广谱肛内酰胺酶（ESBLs）检测采用双纸片协同试验和纸片确证试验。统计分析采用WHONET5软件。结果7年间共检出病原菌16782株，以革兰阴性菌为主，ESBLs和MRS呈逐年上升趋势。1998年产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌分别为17．0％和16．0％；2004年上升到52．2％和44．4％。1998年，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（MRSCN）分别为63．4％和46．7％；2004年上升到76．9％和79．4％。各种菌株的检出比例和耐药性也在不断变化。总的趋势是非发酵菌和葡萄球菌的排序在上升，碳青酶烯类抗生素对肠杆菌科细菌包括ESBLs显示了很好的抗菌活性，耐药率在1％以下；对铜绿假单胞菌耐药率在上升，1998～2001年耐药率低于14％，2002—2004年耐药率已上升至30％～39％。万古霉索对葡萄球菌包括MRS没发现耐药菌。2002年以前，利福平对MRSA的耐药率较低，在9％～35％之间，2003年以后，耐药率迅速增至79％～83％，这种突然的变化可能与近年来结核病抬头，利福平用量增加有关。结论本院病原菌的耐药性变迁符合全球细菌耐药性总趋势，但也有其特殊性。掌握本地区本部门细菌耐药性，对指导临床合理使用抗生素具有实际意义。Objective To survey the drug resistance variation of pathogens. Methods We analysed all the pathogens isolated from January 1998 to December 2004 and the drug resistance results. The repeated strains were deserted. The isolation and identification was proceeded aceording to the guideline of national clinical laboratory（edltion Ⅱ ）published by clinieal laberatory center of national healthy ministry. The susceptibility was done by disk diffusion method. The results were detected by Double Disk synergy test and disk confirmation test. WHONET 5 software was used to analyse the data. Results A total of 16 782 strains pathogens were detected in seven years. The majority was gramstain negative bacteria. There was ascending tendency in ESBLs and MRS. E. Coil and K. pneumonia producing ESBLs, occupied 17.0% and 6.0% in 1998 and the figure tised to 56.2% and 44.4% in 2004,MRSA and MRSCN 63.4% and 46.7% in 1998 while 76.9% and 79.4% in 2004. The ratio of strains and resistance also varied. The general trend was non-fermentation bacteria and staphlococcus were going up. Carbapenems showed good antibiotic effect to enterobacteriaceae including ESBLs, The resistance rate was below 1%. The resistance rate to P.aeruginosa was below 14% between 1998 and 2001 while 30% - 39% between 2002 and 2004 which showed an ascending trend. It was not found that staphylceoceus including MRS were resistant to Vancomycin. The resistance of MRSA to Rifampin was 9% - 35% before 2002 while 79% - 83% after 2003. This change might have something with the use increase of Rifampin due to TB therapy. Conclusion The resistance variation of pathogens in our hospital consists with the global tendency of bacteria resistance. Of course it had its own characteristics. Grasping the bacteria resistance of a given region had great significance for instructing antibiotic use in clinic.

关 键 词：病原菌 耐药性 监测 

分 类 号：R446.5[医药卫生—诊断学]