2013年浙江省金华地区细菌耐药性监测  

Surveillance of bacterial resistance in Jinhua area of Zhejiang province in 2013

作　　者：应华永[1] 卜黎红[1] 单小云[1] 王惠姣[2] 俞北伟 李佳俊 赵升 万汝根 陶兴和 董叶青 董春富 周晓娟 徐根隆 胡苏球 施卫勐 应巧玲 朱葵向 张才富 蒋颜[8] 

机构地区：[1]大学金华医院金华市中心医院检验科,浙江321000 [2]金华市人民医院检验科 [3]东阳市人民医院检验科 [4]武义县人民医院检验科 [5]兰溪市人民医院检验科 [6]永康市人民医院检验科 [7]浦江县人民医院检验科 [8]浙江大学附属第二医院检验科

出　　处：《中华临床感染病杂志》2014年第4期306-313,共8页Chinese Journal of Clinical Infectious Diseases

基　　金：浙江省公益性技术应用研究计划项目（2012C33023）;金华市科技局重点科技计划项目（2011-3-001）

摘　　要：目的探讨浙江省金华地区医院临床分离菌株的分布及其对常用抗菌药物的耐药性。方法连续收集2013年1至12月浙江省金华地区7家综合性医院临床分离菌株。运用全自动化仪器及Kirby-Bauer纸片扩散法进行药敏试验，结果按美国临床实验室标准化协会（CLSI）2012年版标准判断。用WHONET5．6软件进行耐药数据分析。结果共收集到临床分离非重复菌株22830株，其中革兰阴性菌16637株，占72．8％，革兰阳性菌5539株，占24．3％，酵母菌属654株，占2．9％。金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐甲氧西林菌株（MRSA和MRCNS）的检出率分别为37．5％和79．0％。甲氧西林耐药菌株对多数测试药物的耐药率均高于甲氧西林敏感株。葡萄球菌对呋喃妥因、利福平均具有较高的敏感性（〉90％），其中金黄色葡萄球菌对复方磺胺甲嗯唑也具有较高的敏感性（〉84％），未发现万古霉素耐药葡萄球菌。肠球菌属中屎肠球菌对多数测试药物的耐药率均高于粪肠球菌，但对喹奴普汀／达福普汀和四环素的耐药率较粪肠球菌低。两种肠球菌中均检出万古霉素耐药株。大肠埃希菌和克雷伯菌属中产超广谱β-内酰胺酶（ESBLs）菌株的平均检出率分别为53．1％和27．3％。共检测到耐碳青霉烯类药物的肠杆菌科细菌1190株，其中黏质沙雷菌对碳青霉烯类药物的耐药率最高，为42．0％～43．2％。不动杆菌属细菌对亚胺培南和美罗培南的耐药率分别为39．9％和63．8％。铜绿假单胞菌对包括哌拉西林、第三和第四代头孢菌素及氨基糖苷类在内的多数抗菌药物仍有较高的敏感性。相对于白色假丝酵母菌、热带假丝酵母菌和光滑球拟酵母菌，克柔假丝酵母菌对氟康唑、伊曲康唑和伏立康唑的耐药率更高。结论浙江省金华地区细菌耐药形势不容乐观，尤其是耐碳青霉烯类肠杆菌科细菌检�Objective To survey the distribution and drug resistance of clinical isolated bacteria in Jinhua area of Zhejiang province in 2013. Methods Clinical bacterial isolates were successively collected from seven general hospitals in Jinhua area during January and December 2013. Antimicrobial susceptibility testing was carried out using automated systems or by Kirby-Bauer method, and the results were analyzed according to the breakpoints of Clinical and Laboratory Standards Institute （CLSI） 2012. WHONET 5.6software was used for resistance analysis. Results A total of 22 830 clinical isolates were collected, in which 16 637 （72. 8% ） were gram negative strains, 5 539 （24.3%） were gram positive strains, and 654 （2. 9% ） were yeasts. The average prevalence of methicillin-resistant strains in Staphylococcus attreus （MRSA） and in coagulase-negative Staphylococci （MRCNS） was 37.5% and 79.0%, respectively. The resistance rates of methicillin-resistant strains to most of antimicrobial agents tested were much higher than those of methicillin-sensitive strains. More than 90. 0% of Staphylococcus strains were susceptible to nitrofurantoin and rifampin, and more than 84% of Staphylococcus aureus strains were susceptible to compound sulfamethoxazole. No vancomycin resistant Staphylococcus was observed. In Enterococcus spp. , the resistance rates of E. faecium strains to most antimicrobial agents （except quinupristin/dalfopristin and tetracycline） were much higher than those of E. fecalis, and vancomycin-resistant strains were observed in both species. The prevalence of extended-spectrum β-actamase （ESBLs） -producing strains was 53.1% in E. coli and 27.3% in Klebsialla on average. There were 1 190 carbapenemsp-resistant Enterobacteriaceae strains, and Serratia marcescens had the highest resistance rates （42.0% -43.2% ）. The resistance rates of Acinetobacter spp. to imipenem and meropenem were up to 39.9% and 63.8% , respectively. Pseudomonas aeruginosa strains were still highly sensitive to most

关 键 词：抗药性 微生物敏感性试验 抗甲氧西林葡萄球菌 超广谱Β-内酰胺酶 

分 类 号：R446.5[医药卫生—诊断学]