2012年上海地区细菌耐药性监测  

Surveillance of bacterial resistance from hospitals in Shanghai in 2012

作　　者：朱德妹[1] 汪复[1] 郭燕[1] 杨洋[1] 蒋晓飞[1] 王传清[2] 王爱敏[2] 刘瑛[3] 陈峰[3] 倪语星[4] 孙景勇[4] 王靖[5] 李虎[5] 汤瑾[6] 王坚镪[6] 应春妹[7] 汪雅萍[7] 张泓[8] 孔菁[8] 魏丽[9] 王金铎[9] 袁应华[10] 刘妍[10] 胡必杰[11] 黄声雷[11] 陈险峰[12] 殷杏[12] 刘庆中 汤荣 袁轶群[14] 武楠[14] 傅启华[15] 黄卫春[15] 杨海慧 卫颖珏[16] 孙康德[17] 虞中敏[17] 唐群力[18] 冯景[18] 康向东[19] 戴俊华[19] 张正银[20] 孙晴[20] 孙杰[21] 沈思娣[21] 秦云[22] 钱敏健[22] 王蓉[23] 沈燕雅[23] 彭敬红[24] 刘军[24] 朱祖怀[25] 陈超[25] 唐之俭[26] 王芳[26] 汪瑞忠[27] 房华[27] 范惠清[28] 严育忠[28] 朱学源[29] 龚炜[29] 

机构地区：[1]复旦大学附属华山医院抗生素研究所,卫生部抗生素临床药理重点实验室,上海200040 [2]复旦大学附属儿科医院 [3]上海交通大学医学院附属新华医院 [4]上海交通大学医学院附属瑞金医院 [5]第二军医大学附属长海医院 [6]上海交通大学附属第六人民医院 [7]上海交通大学医学院附属仁济医院(浦东) [8]上海交通大学附属上海儿童医院 [9]复旦大学附属上海市第五人民医院 [10]同济大学附属第十人民医院 [11]复旦大学附属中山医院 [12]第二军医大学附属长征医院 [13]上海交通大学附属第一人民医院 [14]复旦大学附属金山医院 [15]上海交通大学医学院附属儿童医学中心 [16]上海交通大学医学院附属仁济医院(浦西) [17]上海交通大学医学院附属第九人民医院 [18]上海市奉贤区中心医院 [19]上海市普陀区中心医院 [20]上海市长宁区中心医院 [21]上海市嘉定区中心医院 [22]上海市崇明县中心医院 [23]上海市第二人民医院 [24]上海市松江区中心医院 [25]上海市普陀区人民医院 [26]上海市青浦区中心医院 [27]上海市浦东新区人民医院 [28]上海市浦东医院 [29]上海市第八人民医院

出　　处：《中国感染与化疗杂志》2013年第6期409-419,共11页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解2012年上海市细菌耐药性监测结果。方法采用纸片扩散法(K-B法)对上海地区29所医院的临床分离菌进行药敏试验,其中包括17所三级医院和12所二级医院。采用CLSI 2012年版标准判断结果。结果总计76 407株临床分离菌,革兰阳性菌占26.6%,革兰阴性菌占73.4%。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的平均检出率分别为52.1%和77.0%。MRSA和MRCNS在二级医院和三级医院的平均检出率分别为67.3%、82.9%和48.3%、76.1%。葡萄球菌属中未发现万古霉素、替考拉宁和利奈唑胺耐药株。685株儿童非脑膜炎分离株中青霉素敏感、中介和耐药肺炎链球菌(PSSP、PISP和PRSP)的检出率分别为72.7%、13.7%和13.6%,75株成人分离株的检出率分别为92.0%、5.3%和2.7%。发现万古霉素耐药屎肠球菌26株、粪肠球菌3株。首次在二级医院中发现万古霉素耐药粪肠球菌2株、屎肠球菌4株。根据表型推测,多数万古霉素耐药肠球菌(VRE)为VanA基因型。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中产ESBLs的检出率分别为60.1%、35.8%和38.9%。上述3种细菌中的ESBLs菌株的检出率在二级医院和三级医院的检出率分别为65.6%、32.5%、51.5%和58.7%、36.6%、32.8%。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,对亚胺培南和美罗培南的总耐药率分别为6.1%和4.1%。铜绿假单胞菌、不动杆菌属对亚胺培南和美罗培南耐药率分别为28.4%、23.2%和50.6%、55.1%。大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中有少数菌株对所有测试药物耐药的泛耐药株(替加环素和多黏菌素未测)。分离自尿液标本中的肠球菌属细菌和大肠埃希菌对磷霉素的耐药率低。结论细菌耐药性仍对临床构成严重威胁,尤其是二级医院中某些细菌的耐药率高于三级医院,应引起严重关注。Objective To investigate the resistance of clinical bacterial isolates to antibiotics in Shanghai hospitals from Jonuary through December in 2012.Methods Antimicobial susceptibility testing was carried out for the clinical isolates from 29 hospitals according to an agreed protocol using Kirby-Bauer (K-B)method.Results were analyzed according to CLSI 2012 breakpoints. Results Of the 76 407 clinical isolates,gram positive cocci and gram negative bacilli accounted for 26.6% and 73.4 %,respec-tively.The overall prevalence of MRSA in Staphylococcus aureus was 52.1% and 77.0% for MRCNS in coagulase-negative Staphylococcus.The average prevalence of MRSA and MRCNS was 67.3% and 82.9% in secondary hospitals,48.3% and 76.1% in tertiary hospitals.No strains were found resistant to vancomycin,teicoplanin or linezolid.About 72.7% of the 685 strains of non-meningitis S.pneumoniae isolated from children were penicillin-susceptible (PSSP),27.3% were penicillin-non-susceptible,including penicillin-intermediate (PISP,13.7%)and penicillin-resistant (PRSP,13.6%)strains.Of the 75 strains isolated from adults,92.0%,5.3% and 2.7% were PSSP,PISP and PRSP,respectively.Overall,26 strains of vaco-mycin-resistant E.feacium and 3 strains of vacomycin-resistant E.feacalis were identified.Most of these resistant strains were VanA type based on their phenotype.Two strains of vancomycin-resistant E.faecalis and 4 strains of vancomycin-resist-ant E.feacium were reported in the secondary hospitals for the first time.The overall prevalence of ESBLs-producing srains was 60.1% in E.coli,35.8% in Klebsiella spp.(K .pneumoniae and K .oxytoca)and 38.9% in P .mirabilis.Specifically, the prevalence of such strains was 65.6%,32.5% and 51.5% in secondary hospitals,58.7%,36.6% and 32.8% in tertiary hospitals,respectively.Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics.Overall,6.1% and 4.1% of the Enterobacteriaceae strains were resistant to imipenem and meropenem,respectively.Of the Acinetobacter spp. strains,50.6% and 55.1

关 键 词：细菌耐药性 抗菌药物 药敏试验 泛耐药菌 

分 类 号：R446.5[医药卫生—诊断学]