中国西部地区脑脊液细菌分布及耐药性分析

目的 了解2016—2017年中国西部脑脊液分离菌的分布及耐药性。方法 中国西部10家医院脑脊液分离株，按统一方案用纸片扩散法或自动化仪器进行抗菌药物敏感性试验，按CLSI(美国临床实验室标准化协会)2016年版标准判断结果。结果10家医院2016—2017年脑脊液标本分离细菌1234株，其中革兰阳性菌697株，占56.5%，革兰阴性菌537株，占43.5%。最常见的分离菌依次为凝固酶阴性葡萄球菌、鲍曼不动杆菌、肺炎克雷伯菌、屎肠球菌、大肠埃希菌、粪肠球菌、肺炎链球菌、醋酸钙不动杆菌、铜绿假单胞菌和金黄色葡萄球菌。脑脊液标本中MRSA和MRCNS的检出率分别为27.9%和66.7%，未发现对万古霉素、替考拉宁和利奈唑胺耐药菌株；粪肠球菌和屎肠球菌对万古霉素的耐药率分别为2.2%和1.6%；大肠埃希菌、肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBL)菌株的检出率分别为64.2%和58.1%，肺炎克雷伯菌对碳青霉烯类抗生素的耐药率(22.2%~23.6%)高于大肠埃希菌(3.6%~4.4%)，铜绿假单胞菌对碳青霉烯类的耐药率45%以上，鲍曼不动杆菌对碳青霉烯类的耐药率高达85%以上。结论 脑脊液分离株对常用抗菌药物耐药性严重，碳青霉烯耐药革兰阴性菌的出现和增多，给脑脊液感染的治疗带来极大挑战，应合理使用抗菌药物，加强医院感染控制，抑制耐药菌的传播。

Distribution and resistance of the bacterial isolated from cerebrospinalfluid in Western China

Objective To investigate the distribution and the antibiotic resistance of the bacterial isolates fromcerebrospinal fluid during the period from 2016 to 2017 in Western China. Methods Cerebrospinal fluid isolateswere collected from 10 hospitals in Western China. Antimicrobial susceptibility testing was carried out according to aunified protocol using the Kirby-Bauer method or automated systems. Results were analyzed according to the breakpointsof CLSI 2016. Results 1,234 bacterial isolates and their antibacterial susceptibility data were collected from all the10 hospitals, which included 697 (56.5% ) Gram-positive bacterial isolates and 537(43.5%) Gram-negative bacterialisolates. The most frequently bacteria were coagulase-negative Staphylococcus(CNS), A. baumannii, K. pneumoniae,E. faecium, E. coli, E. faecalis, S. pneumoniae, A. calcoaceticus, P. aeruginosa, and S. aureus. The prevalence ofMRSA in S. aureus and MRCNS in coagulase-negative Staphylococcus was 27.9% and 66.7%, respectively. Nostaphylococcal strains were resistant to vancomycin, teicoplanin and linezolid. The prevalence of vancomycin-resistantstrain was 2.2% in E. faecalis and 1.6% in E. faecium. ESBLs-producing strains accounted for 64.2% in E. coli and58.1% in K. pneumoniae. The carbapenem resistance rate of K. pneumoniae(22.2%~23.6%) was higher than that of E.coli(3.6%~4.4%). The carbapenem resistance rate of P. aeruginosa was more than 45%, and the resistance rate of A.baumannii to carbapenes was up to 85%. Conclusion The resistance to the first line antibiotic was common amongall isolates from cerebrospinal fluid. Antimicrobial agents should be used appropriately to reduce the selection pressure.Hospital infection control measures should be strengthened to prevent the spread of resistant