2009年中国CHINET细菌耐药性监测  

CHINET 2009 surveillance of bacterial resistance in China

作　　者：汪复[1] 朱德妹[1] 胡付品[1] 阮斐怡[1] 倪语星[2] 孙景勇[2] 徐英春[3] 张小江[3] 胡云健[4] 艾效曼[4] 俞云松[5] 杨青[5] 孙自镛[6] 李丽[6] 贾蓓[7] 黄文祥[7] 卓超[8] 苏丹虹[8] 魏莲花[9] 吴玲[9] 张朝霞[10] 季萍[10] 王传清[11] 薛建昌[11] 张泓[12] 李万华[12] 徐元宏[13] 沈继录[13] 单斌[14] 杜艳[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]中国医学科学院附属协和医院 [4]卫生部北京医院 [5]浙江大学医学院附属第一医院 [6]华中科技大学同济医学院附属同济医院 [7]重庆医科大学附属第一医院 [8]广州医学院附属第一医院 [9]甘肃省人民医院 [10]新疆医科大学附属第一医院 [11]复旦大学附属儿科医院 [12]上海交通大学附属上海儿童医院 [13]安徽医科大学附属第一医院 [14]昆明医学院附属第一医院

出　　处：《中国感染与化疗杂志》2010年第5期325-334,共10页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解国内不同地区14所医院临床分离菌对常用抗菌药物的耐药性。方法国内不同地区14所教学医院(12所综合性医院、2所儿童医院)临床分离菌采用K-B法按统一方案进行细菌药物敏感试验。按CLSI 2009版判断结果。结果 2009年1月—12月收集各医院临床分离菌共43670株,其中革兰阳性菌占29%,革兰阴性菌占71%。金葡菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)平均为52.7%和71.7%。葡萄球菌属中甲氧西林耐药株对β内酰胺类抗生素和其他测试药的耐药率显著高于甲氧西林敏感株,但仍有72%和65% MRSA对磷霉素敏感;89.0%、66.0%和66.7%的MRCNS对利福平、磷霉素和氨苄西林-舒巴坦敏感,未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试药物的耐药率低于屎肠球菌,两者中均有少数万古霉素耐药株,根据表型推测多数为VanA型耐药。本次监测首次出现少数耐利奈唑胺的粪肠球菌和屎肠球菌。非脑膜炎肺炎链球菌(SP)儿童株中PSSP较2008年减少,PISP和PRSP有所增多,在儿童株中首次出现少数喹诺酮类耐药株。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中产ESBLs株分别平均为56.5%和41.4%。肠杆菌科细菌中产ESBLs株对药物的耐药率均比非产ESBLs株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率<2%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为30.5%和25.2%,不动杆菌属(鲍曼不动杆菌占86.8%)对两者的耐药率分别为50.0%和52.4%。与2008年相比肺炎克雷伯菌和鲍曼不动杆菌中的泛耐药株数量显著增多。新出现了5株泛耐药大肠埃希菌和6株泛耐药肠杆菌属细菌。结论细菌耐药性仍呈增长趋势,尤其泛耐药革兰阴性杆菌增多,对临床构成严重威胁。合理选用抗菌药,及早检测泛耐药菌,加强感染控制措施是当务之急。Objective To investigate the resistance of clinical isolates from hospitals in several regions of China. Methods Twelve general hospitals and two children＇s hospitals were involved in this program. Bacterial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method. Results were analyzed according to CLSI 2009. Resuits A total of 43 670 clinical isolates were collected from January to December 2009, of which gram negative organisms and gram positive cocci accounted for 71% and 29% respectively. Methicillin resistant strains in S. aureus （MRSA） and coagulase negative Staphylococcus （MRCNS） accounted for an average of 52.7% and 71.7% respectively. The resistance rates of MR strains to β laetams and other antimicrobial agents were much higher than those of MS strains. However, nearly 72% and 650/00 of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole and fosfomycin, while 89% and 66% of the MRCNS strains were susceptible to rifampin and fosfomycin. No staphylococcal strain was resistant to vancomycin, teicoplanin or linezolid. The resistance rate of E. faecalis strains to most of the drugs tested was much lower than those of E. faecium. Some strains of both E. faeciurn and E. faecalis were found resistant to vancomycin, teicoplanin or linezolid. Most of the vancomycin-resistant strains were Van-A type based on their phenotype. Some linezolid-resistant E. faecium and E. faecalis isolates were first reported in our surveillance. Regard ing non-meningitis S. pneumoniae strains, the number of PSSP were less than those isota＇ted in 2008 in children strains, while the number of PRSP increased. Moreover, quinolone-resistant children strains were found for the first time. Strains of Enterobacteriaceae were still highly susceptible to imipenem and meropenem, the overall resistance rates being less than 2 %. Resistance rates of P. aeruginosa to imipenem and meropenem were 30.5 % and 25.2%, respectively. The resistance rates of Acinetobacter spp. to the two

关 键 词：细菌耐药性监测 细菌药物敏感试验 多重耐药菌 泛耐药革兰阴性杆菌 万古霉素耐药肠球菌 甲氧西林耐药金葡菌 超广谱Β内酰胺酶 

分 类 号：R446.5[医药卫生—诊断学]