2011年东莞市太平人民医院细菌耐药性监测  

Surveillance of antimicrobial resistance in clinical isolates from Taiping People′s Hospital in Dongguan during 2011

作　　者：李明[1] 周湧[1] 郭文婷[1] 江俊兵[1] 卢炯堂[1] 邓志坚[1] 

机构地区：[1]广东省东莞市太平人民医院检验科,523907

出　　处：《中国感染与化疗杂志》2013年第1期65-71,共7页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解广东省东莞市太平人民医院2011年临床分离菌对常用抗菌药物的耐药情况。方法肺炎链球菌采用法国生物梅里埃公司的ATB STREP5药敏试验板条,流感嗜血杆菌和卡他莫拉菌采用法国生物梅里埃公司的ATB HAEMO药敏试验板条进行抗菌药物的敏感性试验,其他细菌采用纸片扩散法(K-B法)进行抗菌药物敏感性试验,以CLSI 2010年版为判断标准,数据分析采用WHONET5.5软件。结果临床分离的1 355株细菌中,革兰阴性菌占64.6%(876/1 355),革兰阳性菌占35.4%(479/1 355)。MRSA和MRCNS的检出率分别为23.2%和86.7%,肺炎链球菌对青霉素的敏感率为97.5%。未检出糖肽类抗生素耐药的革兰阳性球菌。肠杆菌科细菌对亚胺培南、美罗培南高度敏感,产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别为58.4%(153/262)和39.9%(55/138)。从血培养中检出1株耐碳青霉烯类抗生素的大肠埃希菌,表型检测显示其产金属酶。鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮-舒巴坦和米诺环素的耐药率均低于20%。泛耐药鲍曼不动杆菌的检出率(19.2%,10/52)较2009年(3.3%,3/90)有明显上升。铜绿假单胞菌对亚胺培南、美罗培南、环丙沙星和左氧氟沙星的耐药率均低于10%。嗜麦芽窄食单胞菌对甲氧苄啶-磺胺甲口恶唑、左氧氟沙星和米诺环素的耐药率较低。未发现对阿莫西林-克拉维酸和头孢噻肟耐药的流感嗜血杆菌和卡他莫拉菌。结论 2011年该院临床分离菌较以往的监测有较大变化,但仍以革兰阴性杆菌为主,所分离的革兰阴性杆菌对碳青霉烯类抗生素高度敏感。苛养菌中肺炎链球菌和流感嗜血杆菌所占比率有所上升。定期进行细菌耐药性监测有助于了解该院细菌及其耐药性的变迁,为临床经验用药和合理用药提供依据。Objective To investigate the resistance of clinical isolates to antimicrobial agents commonly used in Taiping People＇ s Hospital, Dongguan during 2011. Methods ATB STREP 5 was used for susceptibility testing of Streptococcus pneumoniae, ATB t-IAEMO for Haemophilus influenzae and Moraxella catarrhalis. Disk diffusion susceptibility test was used to deter- mine the antimicrobial susceptibility of other bacteria. The data were analyzed by WHONET 5.5 software according to CLSI 2010 breakpoints. Results Of the 1 355 clinical isolates, gram negative bacilli and gram positive cocci accounted for 64. 6% （876/1 355） and 35.4% （479/1 355） respectively. About 23.2% of the S. aureus isolates were identified as MRSA, 80.7% of the coagulase negative Staphylococcus isolates were identified as MRCNS. Overall, about 97.5% of the Streptococcus pneu moniae strains were sensitive to penicillin. No strain of gram-positive cocci was found resistant to glycopeptides. Isolates of En- terobacteriaceae were highly sensitive to carbapenems. About 58.4% （153/262） of the E. coli isolates and 39.9% （55/138） of the K. pneumoniae isolates were ESBLs-producing strains. One carbapenem-resistant strain of Escherichia coli was isolated from blood culture. Phenotype test showed that it produced metalloenzyme. The percentage of the A. baumannii isolates re sistant to imipenem, meropenem, cefoperazone-sulbactam, or minocycline was lower than 20%. The prevalence of pan-resist-ant strains in A. baumannii （19. 2%, 10/52） was significantly higher than the data in 2009 （3. 3%, 3/90）. Not more than 10% of P. aeruginosa isolates were resistant to imipenem, meropenem, ciprofloxacin, or levofloxacin.Stenotrophomonas maltophilia strains were relatively susceptible to sulfamethoxazole-trimethoprim, levofloxacin, minocycline with lower resistance rate. No strains of Haemophilus influenzae or Moraxella catarrhalis were found resistant to amoxicillin clavulanate or cefotaxime. Conclusions The resistant pattern of clinical bacterial isolate

关 键 词：药敏试验 细菌耐药性监测 甲氧西林耐药金黄色葡萄球菌 金属酶 

分 类 号：R446.5[医药卫生—诊断学]