四川省细菌耐药监测网2013年川西地区细菌耐药监测  

Sichuan provincial of antimicrobial resistant investigation net report in 2013: Bacterial distribution and resistance surveillance in Western Sichuan

作　　者：史梦 保勇[1] 尹亚非[1] 陆玲[1] 任萨瑛 周勇[1] 喻华[2] 

机构地区：[1]成都市第二人民医院检验科,成都610017 [2]四川省医学科学院四川省人民医院检验科,成都610072

出　　处：《中国抗生素杂志》2015年第6期439-444,463,共7页Chinese Journal of Antibiotics

摘　　要：目的掌握2013年川西地区医院临床分离菌的构成比及对抗菌药物的耐药性,指导抗菌药物临床应用。方法监测2013年川西地区27所医院临床分离菌,采用K-B纸片扩散法或自动化仪器法进行抗菌药物敏感试验,按CLSI2013年标准,采用WHO-NET 5.6软件进行统计分析。结果 27家医院按照监测方案从各种临床标本中共分离出51470株细菌。其中,革兰阴性菌38255株(占74.3%),革兰阳性菌13215株(占25.7%)。葡萄球菌中,耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为30.4%和66.8%。未发现对利奈唑胺和万古霉素耐药的葡萄球菌,但值得注意的是开始出现耐替考拉宁的金黄色葡萄球菌。屎肠球菌的分离率已经超过粪肠球菌,屎肠球菌和粪肠球菌对万古霉素的耐药率分别为7.7%和1.0%。非发酵菌对碳青霉烯类的耐药率较高,鲍易不动杆菌耐药率进一步增加。大肠埃希菌和克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中产ESBLs株分别为53.0%和28.4%。肠杆菌科细菌对碳氢酶烯类药物仍保持高度敏感,但敏感率较2012年有所下降。结论许多常见病原菌对抗菌药物的耐药性严重,加强细菌耐药性监测对促进抗菌药物的合理使用非常重要。Objective To investigate the bacterial distribution and resistance of clinical isolates in Western Sichuan in 2013 so as to provide clinical reference in the use of antibacterial agents. Methods A total of 27 hospitals participated in this program. Bacterial susceptibility test was performed using Kirby-bauer method or automated system. Results were analyzed by WHONET 5.6 referring to the breakp0ints of CLSI 2013. Results A total of 51470 bacterial isolates were isolated from various clinical specimens according to a unified protocol, which included 38255（74.3%） strains of gram-negative bacteria and 13215（25.7%） strains of Gram-positive bacteria. Methicillin- resistant Staphylococcus aureus （MRSA） and methicillin-resistant coagulase-negative Staphylococci （MRCNS） detection rates were 30.4% and 66.8%. No staphylococcal strains were found resistant to linezolid and vancomycin. It is noteworthy that a few Staphylococcus aureus were found resistant to teicoplanin. The isolation rate of E. faecium was higher than that ofE. faecalis. 7.7% ofE. faecium and 1.0% ofE. faecalis were resistant to vancomycin.The non- fermenting bacteria were highly resistant to carbapenems, and the drug resistance rate fo A. baumannii was increased.The prevalence of ESBLs-producing strains was 53.0% in E. coli and 28.4% in K.lebsiella spp. （K. pneumoniae and K. oxytoca）. The strains of Enterobacteriaceae were still highly susceptible to carbapenems, but the drug susceptibility rate declined as compared with 2012. Conclusion Some of the common pathogens are with serious resistance to commonly use antibiotics. Strengthening the surveillance for bacterial resistance is very important for the promotion of reasonable use of antibiotics.

关 键 词：细菌耐药监测 抗菌药物 药敏试验 

分 类 号：R378[医药卫生—病原生物学]