Mohnarin 2011年度报告:尿标本细菌耐药监测  

Mohnarin report of 2011:monitoring of drug resistance of bacteria from urine specimens

作　　者：杨青[1] 陈晓[1] 孔海深[1] 张伟丽[1] 魏泽庆[1] 沈萍[1] 陈云波[1] 肖永红[1] 李兰娟[1] 

机构地区：[1]浙江大学医学院附属第一医院传染病诊治国家重点实验室,浙江杭州310003

出　　处：《中华医院感染学杂志》2012年第24期5503-5507,共5页Chinese Journal of Nosocomiology

基　　金：卫生行业科研专项项目(201002021)

摘　　要：目的了解我国尿路感染常见病原菌的分布及耐药性,为临床应用抗菌药物提供指导依据。方法对49所卫生部全国细菌耐药监测网(Mohnarin)成员单位分离自尿标本的细菌进行常规鉴定,采用纸片扩散法(K-B法)或自动化细菌鉴定系统测定细菌的耐药性,按CLSI 2010年版折点判断结果并采用WH0NET 5.6软件进行统计分析。结果共分离到细菌15 541株,其中革兰阳性菌4060株占26.1%,革兰阴性菌11 481株占73.9%,最常见细菌为大肠埃希菌7102株、屎肠球菌1337株、粪肠球菌1262株、肺炎克雷伯菌1142株、铜绿假单胞菌669株,分别占45.7%、8.6%、8.1%、7.3%、4.3%;大肠埃希菌和肺炎克雷伯菌ESBLs检出率分别为67.8%、64.9%,对碳青霉烯类抗菌药物最敏感,耐药率<3.0%,对阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率均<20.0%;屎肠球菌对各种抗菌药物的耐药率明显高于粪肠球菌,耐万古霉素肠球菌检出率分别为3.3%、1.0%;耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌检出率分别为41.9%、77.7%,未检测到耐万古霉素菌株。结论我国尿路感染病原菌以大肠埃希菌为代表的革兰阴性杆菌为主,多药耐药菌株增加,细菌耐药性监测对及时了解病原菌及其耐药性非常重要。OBJECTIVE To investigate the distribution and drug resistance of common pathogens causing urinary tract infections so as to provide basis for clnical use of antibiotics.METHODS All bacterial isolates from urine samples in 49 Mohnarin member hospitals were collected,antimicrobial susceptibility testing was carried out by K-B method or automatic microbiological analysis system,and the data were analyzed by Whonet 5.6 software according to CLSI 2010 breakpoints.RESULTS A total of 15 541 strains of clinical isolates were collected,consisting of 4060（26.1%） strains of gram-negative bacilli and 11 481（73.9%） strains of gram-positive cocci.The most common isolates were Escherichia coli（7102 strains,45.7%）,Enterococcus faecium（1337 strains,8.6%）,Enterococcus faecalis（1262 strains,8.1%）,Klebsiellia pneumoniae（1142 strains,7.3%）,and Pseudomonas aeruginosa（669 strains,4.3%）.The prevalence of extended-spectrum β-lactamases（ESBLs） was 67.8% in E.coli,64.9% in K.pneumoniae.Imipenem and meropenem were the most potent antimicrobial agents against Enterobacteriaceae with the drug resistance rate less than 3.0%,the resistance rates to amikacin,cefoperazone-sulbactum and piperacillin-tazobactam were also less than 20.0%.E.faecium had higher resistance rates to almost all the antibiotics than did E.faecalis.The detection rates of the vancomycin-resistant E.faecalis and E.faecium were 3.3% and 1.0%.The detection rates of methicillin-resistant S.aureus（MRSA） and coagulase-negative Staphylococcus（MRCNS） were 41.9% and 77.7%,respectively.no vancomycin-resistant isolates were found.CONCLUSION The gram-negative bacilli such as E.coli are the predominant pathogens causing urinary tract infections in China,the multidrug-resistant pathogens have also increased,and it is very important for understanding the pathogens and the drug resistance to perform the monitoring of the bacterial resistance.

关 键 词：卫生部全国细菌耐药监测网 尿路感染 病原菌 耐药性 

分 类 号：R181.32[医药卫生—流行病学]