Mohnarin 2008年度报告:葡萄球菌和肠球菌耐药监测  

2008 Mohnarin report:Results of Staphylococcus and Enterococcus resistance

作　　者：徐修礼[1] 张鹏亮[1] 樊新[1] 孙怡群[1] 刘家云[1] 

机构地区：[1]第四军医大学西京医院全军临床检验医学中心,西安710032

出　　处：《中国抗生素杂志》2010年第7期536-542,共7页Chinese Journal of Antibiotics

摘　　要：目的总结我国89家医院2008年度临床分离葡萄球菌和肠球菌的耐药状况。方法常规方法培养分离临床感染标本中的葡萄球菌和肠球菌,应用半自动或全自动细菌鉴定分析仪鉴定到种,药敏试验按临床和实验室标准化委员会(CLSI)规定的标准进行。监测数据按卫生部全国细菌耐药监测(Mohnarin)中心设计方案上报,用WHONET5.4软件统计分析。结果从89家医院共分离获得葡萄球菌32378株,肠球菌12127株,分别占革兰阳性菌的63.6%和23.8%。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)的发生率分别为67.6%、79.9%;ICU病区MRSA发生率为51.2%;不同地区MRSA发生率在52.3%～76.9%之间;不同标本MRSA分离率分别为:痰液标本48.7%,血液标本42.0%,分泌物标本18.8%。MRSA对米诺环素、氯霉素、呋喃妥因和替考拉宁的敏感率分别为84.6%、86.5%、93.4%和97.7%;对氟喹诺酮类、氨基糖甙类、克林霉素和利福平的敏感率为4.9%～48.7%;未发现对万古霉素和利奈唑胺耐药的葡萄球菌。肠球菌对利奈唑胺均敏感;共发现205株耐万古霉素肠球菌(VRE),粪肠球菌和屎肠球菌对万古霉素的耐药率分别为1.3%和1.4%。结论我国VRE分离率虽然较低,但临床应严格监控其耐药性的扩散;利奈唑胺、万古霉素和替考拉宁对葡萄球菌和肠球菌体外抗菌活性均较好,但临床应根据患者自身具体的感染情况采取个体优化治疗方案;耐甲氧西林葡萄球菌分离率仍较高,临床应采取更加有效的防止交叉感染和消毒灭菌措施。Objective To summarize drug resistance of clinical isolated Staphylococcus and Enterococcus of 89 hospitals in 2008. Methods Isolates were cultured by routine method and identified by the semi-automatic or automatic bacteria identification analysis system. Drug susceptibility test was according to CLSI standards. Supervising data delivered to Ministry of Health National Antimicrobials Resistant Investigation Net（Mohnarin） according to its require. Data statistic and analysis used WHONET5.4 software. Results 32,378 strains staphylococci （63.6%）and 12,127 strains enterococci（23.8%） were isolated from 89 hospitals, in which the separated rate of MRSA and MRCNS was 67.6% and 29.9% respectively. The separated rate of MRSA in ICU ward and in different district were 51.2% and 52.3%-76.9%. The separated rate of MRSA in different specimen were sputum 48.7%, blood 42.0% and secretion 18.8%. The sensitive rates of MRSA against minocycline, chloramphenicol, nitrofurantoin and teicoplanin were 84.6%, 86.5%, 93.4% and 97.7% respectively, but that against fluoroquinolones, aminoglycoside, clindamycin and rifampicin were from 4.9% to 48.7%. We didn＇t find resistance to vancomycin and linezolid against staphylococci, enterococci against linezolid were all sensitive. 205 strains enterococci against vancomycin were resistant. The drug resistant rates of E. faecalis and E. faecium against vancomycin were 1.3% and 1.4%. Conclusion The separated rate of vancomycin resistant Entarococcus was low, but its drug resistantance should be supervised strictly in clinic. In vitro linezolid, vancomycin and teicoplanin showed a strong antibacterial activity against Staphylococcus and Enterococcus, but individual optimization treatment scheme should be used according to patient infectious situation. With the high separating rate of methicillin resistance Staphylococcus, effective measurement of disinfection and sterilization and against cross infection should be used in clinic.

关 键 词：MOHNARIN 葡萄球菌属 肠球菌属 细菌耐药监测 2008年 

分 类 号：R378.1[医药卫生—病原生物学]