2004～2005年我院临床常见细菌耐药性监测  

Surveillance of bacterial resistance from a hospital in Chongqing from 2004 to 2005

作　　者：卓超[1] 黄文祥[1] 郑行萍[1] 李崇智[1] 夏云[1] 杜渝平[1] 

机构地区：[1]重庆医科大学附属第一医院重庆市传染病学重点实验室,重庆400016

出　　处：《中国抗生素杂志》2007年第5期308-312,共5页Chinese Journal of Antibiotics

摘　　要：目的 调查中国细菌耐药性监测协助组（CHINET）重庆工作组2004年11月--2005年11月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 一年中我院共收集患者首次分离株1380株；大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、凝固酶阴性葡萄球菌、金葡菌、阴沟肠杆菌和粪肠球菌为最常见菌，所占比例分别为18．6％、13．6％、11．3％、10．0％、9．4％、9．1％、8．0％和3．9％。肠杆菌科细菌对亚胺培南和美罗培南的耐药率最低，产超广谱p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37．5％和31．4％；所有ESBLs产生株对亚胺培南和美罗培南均敏感，铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为37．2％和39．4％，对头孢他啶的耐药率达48．9％，且出现对所有药物耐药的泛耐株。鲍曼不动杆菌对亚胺培南和美罗培南的敏感率分别为98．6％和92．8％，对头孢哌酮／舒巴坦的敏感率、中介率、耐药率分别为34．8％、27．5％、37．7％。耐药组合分析显示，对头孢哌酮／舒巴坦不敏感株中有58株为完全相同的耐药模式，PFGE分析，这些菌株主要来源于两个克隆株。除碳青霉烯类敏感外，其余药物均耐药，其中46株来源于同一病区。结论 我院近半年的常见细菌耐药性与前期监测结果相似，但由于在一些监护病房存在耐头孢哌酮／舒巴坦流行株，使鲍曼不动杆菌对头孢哌酮／舒巴坦的敏感率明显低于前期监测结果。采取有效措施控制流行株继续传播是非常重要的。Objective To investigate the antimicrobial resistance of clinical isolates from a hospital in Chongqing during 2004-2005 according to CHINET project. Methods Disc diffusion test （KB methods） was employed to study the antimicrobial resistance. WHONET5 was applied for analysis. Results In one year of study, 1380 strains were collected which were firstly isolated from patients. E. coli, P. aeruginosa, K. pneumoniae, A. baumannii, coagulase-negative staphylococci, S. aureus, Enterobacter cloacae and E. faecalis were the most common strains among isolates. The resistant rate of Enterobacter to imipenem and meropenem were the lowest. The incidence of E. coli and K. pneumoniae producing ESBLs were 37.5% and 31.4%, respectively. All the ESBLs-producing strains are susceptible to imipenem and meropenem. 37.2%, 39.4% and 48. 9% of P. aeruginosa were resistant to imipenem, meropenem and ceftazidime, respectively, and pandrug- resistant （PDR） strains of P. aeruginosa have exhibited in our hospital. All strains of A. baumannii were susceptible to imipenem and meropenem, while only 34.8% of the strains were susceptible to cefoperazone/sulbactam. There are 58 strains shown the same resistant pattern among non-susceptible strains of A. baurnannii, in which 46 were isolated from the same ward. Conclusion The surveillance results in this year were similar with that in last year. There may be cloning strains of resistant to cefoperazone/sulbactam in some ICU, which resulted in the resistant rate of cefoperazone/sulbactam were higher than before. It is important to take measures to control the transmission of cloning strains in the hospital.

关 键 词：细菌耐药性 抗菌药物 革兰阳性球菌 革兰阴性杆菌 

分 类 号：R378.1[医药卫生—病原生物学]