2012年度全国三级医院重症监护病房来源细菌耐药分析  

Surveillance of antimicrobial resistance among clinical isolates from intensive care units in tertiary hospital,2012

作　　者：张小江[1] 郑波[2] 吕媛[2] 徐英春[1] 

机构地区：[1]中国医学科学院北京协和医院检验科,北京100730 [2]北京大学第一医院临床药理研究所,北京100034

出　　处：《中国临床药理学杂志》2015年第11期970-975,共6页The Chinese Journal of Clinical Pharmacology

基　　金：国家科技支撑计划基金资助项目(2012EP001002)

摘　　要：目的：分析我国2012年重症监护病房（ ICU）患者病原菌的分布及其耐药性。方法收集全国557家三级医院ICU分离非重复的细菌，药敏试验按美国实验室标准化协会（CLSI）2012推荐方法进行，用WHONET 5.6软件进行数据分析。结果94178株非重复的细菌中，革兰氏阴性菌占75.6％，革兰氏阳性菌占24.4％。5种最常见的细菌依次为鲍曼不动杆菌（15.8％），肺炎克雷伯菌（14.7％），铜绿假单胞菌（12.8％），大肠埃希菌（12.5％），金黄色葡萄球菌（8.5％）。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57.5％和83.7％。金黄色葡萄球菌对磺胺甲噁唑／甲氧苄啶敏感率为69.2％，凝固酶阴性葡萄球菌（ CNS）对利福平敏感率为83.9％。未发现对万古霉素，替考拉宁和利奈唑胺耐药的金黄色葡萄球菌。CNS对替考拉宁耐药率为2.1％。粪肠球菌和屎肠球菌对万古霉素，替考拉宁和利奈唑胺的耐药率分别为1.8％，3.1％，2.3％和5.9％，5.9％，1.4％。产超广谱β内酰胺酶（ ESBLs）对大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌和奇异变形杆菌的检出率分别为67.5％，45.4％，32.5％和39.5％。肠杆菌科细菌对碳青霉烯类耐药率为2.2％～10.4％。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为70.8％和69.2％。铜绿假单胞菌对上述两种抗菌药的耐药率分别为38.5％和37.4％。结论 ICU中细菌对抗菌药的耐药性仍很严重，特别是对碳青霉烯类耐药的肠杆菌细菌和鲍曼不动杆菌，应采取有效的医院感染控制措施和抗菌药的合理使用。Objective To investigate the distribution and antimicrobial resistance of clinical isolates derived from intensive care unit（ICU） pa-tients in China in 2012.Methods A total of 94178 non -duplicate clinical isolates from ICU of 557 tertiary hospitals were collected from January 2012 to December 2012.Antimicrobial susceptibility testing was carried out according to a unified using disc diffusion test （ Kirby-Bauer method ） or automated systems.The data were analyzed by WHONET 5.6 software according to Clinical and Laboratory Standards Institute （ CLSI） 2012 breakpoints.Results Among these 94178 non-duplicate clinical isolates, gram-negative organisms and gram-positive organisms accounted for 75.6% and 24.4%, respectively.The 5 most common pathogens in ICU were Acinetobacter baumannii （ 15.8%） , Klebsiella＆amp;nbsp;pneumoniae （ 14.7%） , Pseudomonas aeruginosa （ 12.8%） , Escherichia coli （ 12.5%） and Staphylococcus aureus （8.5%）.Methicillin -resistant Staphylococcus aureus （ MRSA ） strains and coagulase -negative Staphylococcus （ MRCNS） accounted for 57.5% and 83.7%, respectively.However, 69.2% of Staphylococcus aureus strains were still susceptible to trimethoprim -sulfamethoxazole, while 83.9% of CNS strains were susceptible to rifampin.No Staphylococcus aureus strain was resistant to vancomycin, teicoplanin and linezolid.2.1% of the CNS strains were found resistant to teicoplanin.The resistant rates of Enterococcus faecalis and Enterococcus faecium to vancomycin, teicoplanin and linezolid were 1.8%, 3.1%,2.3% and 5.9%,5.9%1.4%, respectively.Extended spectrum β-lactamases （ ESBLs）-producing strains accounted for 67.5%, 45.4%, 32.5%and 39.5%in Escherichia coli, Kleb-siella pneumoniae, Klebsiella oxytoca and Proteus mirabilis, respectively.Overall, 2.2%-10.4%of the Enterobacteria-ceae strains were resistant to carbapenems.The resistance rates of Acinetobacter baumannii to imipenem and meropenem were 70.8 and 69.2%, respectively.The resistance rates of Pseudomonas aerugin

关 键 词：细菌耐药 重症监护病房 药敏试验 抗菌药 

分 类 号：R978.1[医药卫生—药品] R969.3[医药卫生—药学]