2009年武汉同济医院细菌耐药性监测  

Surveillance of antimicrobial resistance in clinical isolates from Wuhan Tongji Hospital in 2009

作　　者：朱旭慧[1] 孙自镛[1] 李丽[1] 张蓓[1] 陈中举[1] 田磊[1] 王斌[1] 朱琴[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院检验科,武汉430030

出　　处：《中国感染与化疗杂志》2010年第5期342-348,共7页Chinese Journal of Infection and Chemotherapy

摘　　要：目的分析我院2009年临床分离常见病原菌对常用抗菌药物的耐药情况。方法 E试验法检测肺炎链球菌对青霉素和头孢曲松以及葡萄球菌对万古霉素的MIC,其他抗菌药物采用纸片扩散法进行药敏试验。根据CLSI2008年M100-S18判定耐药性。结果收集本院2009年5791株临床分离细菌,其中革兰阴性杆菌占59.8%(3465/5791),革兰阳性球菌占28.9%(1676/5791),真菌10.9%(630/5791)。住院患者中常见的分离菌依次为大肠埃希菌、不动杆菌属、肺炎克雷伯菌、金葡菌和铜绿假单胞菌;门诊患者则依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、流感嗜血杆菌和金葡菌。金葡菌和凝固酶阴性葡萄球菌(CNS)中MRSA和MRCNS的检出率分别达到62.9%(350/556)和83.4%(399/478),检出万古霉素和(或)替考拉宁耐药的肠球菌属6株;青霉素不敏感肺炎链球菌(PISP+PRSP)的分离率为30.1%(非脑脊液标本);4株脑脊液分离菌株均为青霉素耐药肺炎链球菌(PRSP)。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,但耐药菌株亦已出现。产ESBLs大肠埃希菌和产ESBLs克雷伯菌属的检出率分别高达78.3%(626/800)和49.8%(311/625)。不动杆菌属中耐亚胺培南和美罗培南株占50%以上;耐亚胺培南和美罗培南的铜绿假单胞菌分别为20.3%和11.2%;嗜麦芽窄食单胞菌对左氧氟沙星、磺胺甲口恶唑-甲氧苄啶、米诺环素的敏感性较好(77.3%～92.4%)。结论我院常见病原菌仍以革兰阴性杆菌为主,细菌多重耐药现象严重,尤其对万古霉素耐药肠球菌属和碳青酶烯类抗生素耐药鲍曼不动杆菌增多。应及早进行检测并采取有效控制措施。Objective To investigate the antibiotic resistance of clinical strains isolated from Tongji Hospital to antimicrobial agents commonly used during 2009. Methods The minimum inhibitory concentrations （MICs） of penicillin, ceftriaxone for S. pneurnoniae and vancomycin for Staphylococcus spp. were determined by E-test. Other antimicrobial susceptibility was tested by Kirby-Bauer method. Drug resistance was judged according to the Clinical and Laboratory Standards Institute （CLSI） 2008 M100-S18. Results A total of 5 791 bacterial strains were isolated in 2009. Gram positive cocci, Gram-negative bacilli and Fungus accounted for 28.9% （1 676/5 791）, 59.8% （3 465/5 791） and 10.9% （630/5 791）, respectively. For in patients, the top 5 isolates were E. coli, Acinetobacter spp. , K. pneumoniae, S. aureus and P. aeruginosa. But for out patients, E. coli, P. aeruginosa, K. pneumoniae, H. influenzae and S. aureus were the most common pathogens. The prevalence of MRSA and MRCNS were 62. 9% （350/556） and 83. 4% （399/478）, respectively in 2009. Strains resistant to vancomycin and/or teieoplanin were found in Enterococcus （6 isolates）. The prevalence of penicillin non-susceptible S. pneumoniae （PNSSP） was 30.1 % （non-meningitis）. All the 4 isolates from cerebrospinal fluid were penicillin-resistant S. pneurnoniae （PRSP）. Strains of Enterobacteriaceae were still highly susceptible to imipenem and meropenem. But we also identified a few resistant strains. The prevalence of ESBLs-producing E. coli and Klebsiella spp. was 78.3% （626/800） and 49.8% （311/625）, respectively.The prevalence of carbapenems resistant Acinetobacter spp. was higher than 50%, while the prevalence of imipenem and meropenem resistant P. aeruginosa was 20.3 % and 11.2%, respectively. X. maltophilia was highly susceptible to levo floxacin, sulfamethoxazole-trimethoprim and minocycline.About 77.3 % to 92.4 % of the isolates were susceptible to these 3 antibiotics. The sensitivity of H. influenzae isolates to sulfame

关 键 词：药敏试验 耐药性监测 耐甲氧西林金黄色葡萄球菌 耐万古霉素肠球菌 超广谱Β内酰胺酶 多重耐药细菌 

分 类 号：R446.5[医药卫生—诊断学]