2008—2010年郑州市某院革兰阳性球菌耐药监测研究  

Resistance surveillance of Gram-positive cocci in a hospital in Zhengzhou from 2008 to 2010

作　　者：郭皓[1] 徐莉娟[1] 徐岷[1] 宋春花[2] 

机构地区：[1]郑州大学第一附属医院检验科,郑州450052 [2]郑州大学公共卫生学院,郑州450052

出　　处：《中国抗生素杂志》2012年第12期940-947,共8页Chinese Journal of Antibiotics

基　　金：浙江省重大科技专项(2009C13G2020012);浙江省自然科学基金(Y4090605)

摘　　要：目的了解我院2008—2010年临床分离革兰阳性球菌对抗菌药物的耐药性。方法收集我院2008—2010年临床分离革兰阳性球菌5459株,采用K-B(Kirby-Bauer)法和2008—2010年各年判断标准(CLSI)进行革兰阳性球菌的耐药性监测。应用WHONET 5.4及SPSSl9.0软件进行统计分析。结果 5459株临床分离株中,以葡萄球菌属分离率最高(60.7%)葡萄球菌属及肠球菌属临床分离率三年来有上升趋势;葡萄球菌属对头孢类及喹诺酮类药物的耐药率三年来呈上升趋势且差别有统计学意义(P<0.05),未发现万古霉素中介株和耐药株(VISA和VRSA);MRSA对红霉素、复方磺胺甲噁唑的耐药率逐年上升,而对庆大霉素的耐药率下降明显,差别均具有统计学意义(P<0.05);肠球菌对利奈唑胺无耐药株,但对糖肽类抗生素万古霉素、替考拉宁已分别出现平均4.5%、3.2%的耐药菌株及6.3%、0.43%的中敏株,屎肠球菌对所有监测药物的耐药性均明显高于粪肠球菌,且对近半数的监测药物的耐药性均>80%;粪肠球菌对万古霉素、替考拉宁、氨苄西林、青霉素G及左氧氟沙星的耐药率呈下降趋势且差别有统计学意义(P<0.05);肺炎链球菌属分离率三年来上升明显,比率增加了31.9%,且其对青霉素的耐药率有逐年上升趋势,左氧氟沙星是唯一监测到对肺炎球菌耐药率呈下降趋势的抗菌药物且差别有统计学意义(P<0.05);溶血性链球菌对各类监测药物的耐药率均明显低于草绿色链球菌及肺炎链球菌,仅对红霉素及克林霉素的耐药率较高。结论各类革兰阳性球菌对监测抗菌药物的耐药性有逐年增加趋势,其耐药性变迁有助于指导临床用药。Objective To investigate the antibiotic resistance of Gram-positive cocci clinical isolates from our hospital from 2008 to 20i0. Methods 5459 Gram-positive cocci strains were isolated, antimicrobial susceptibility was tested by Kirby-Bauer method and drug susceptibility tests were evaluated according to CLSI standards（2008-2010）. WHONET5.4 and SPSS19.0 software data were used to analyze the data. Results The isolation rate of Staphylococcus was the highest（60.7）% in 5459 Gram-positive cocci strains, there is an increasing trend of Staphylococcus and Enterococcus clinical isolate rates over the last three years; the resistance rates of cephalosporins and quinolones against Staphylococcus showed an increasing trend and the differences were statistically significant（P〈0.05）, vancomycin-intermediate Staphylococcus aureus （VISA） and vancomycin-resistance Staphylococcus aureus （VRSA） were not found; the resistance rate of erythromycin and cotrimoxazole against MRSA increased year by year, but the resistance rate decreased obviously for gentamycin and all of the differences were statistically significant（P〈0.05）; linezolid resistant strains weren＇t found in Enterococcus strains, but there were average 4.5%, 3.2% resistant strains and 6.3%, 0.43% middle sensitive strains on glycopeptide antibiotic vancomycin and teicoplanin, all monitoring drugs＇ resistance against Enterococcus faecium was significantly higher than those of Enterococcus faecalis, and nearly half of the monitoring drug resistant rates was more than 80%, The resistant rate of Enterococcusfaecalis to vancomycin, teicoplanin, ampicillin, penicillin G and levofloxacin decreased and the difference was statistically significant（P〈0.05）; the isolation rate of Streptococcus pneumoniae increased obviously over the last three years（increasing 31.9%）, the resistance rate of penicillin against SP increased year by year, levofloxacin which resistant rate decreased was the only monitor drug and the difference was statistically

关 键 词：革兰阳性球菌 细菌耐药性 耐药监测 抗菌药物 

分 类 号：R378[医药卫生—病原生物学]