2010年中国12所教学医院革兰阳性球菌耐药性研究

目的调查2010年我国12所教学医院临床分离的革兰阳性球菌的耐药性。方法收集2010年6-12月9个城市12所教学医院临床分离的1 181株非重复革兰阳性球菌。采用琼脂稀释法测定抗菌药物的最低抑菌浓度(MIC)值,计算不同病原菌对常用临床抗菌药物的耐药率。结果金葡菌和凝固酶阴性葡萄球菌中耐苯唑西林菌株分别占40.6%(191/470)和79.6%(187/236);不同标本苯唑西林耐药金葡菌(MRSA)检出率为22.2%～72.7%。在ICU患者中,MRSA的检出率为71.4%,高于MRSA在住院患者中的比率。未发现对替考拉宁、万古霉素和利奈唑胺耐药的金葡菌;替加环素对金葡菌的MIC值范围为0.032～0.5 mg/L。在肠球菌属中发现10株屎肠球菌和2株粪肠球菌对万古霉素耐药。粪肠球菌和屎肠球菌对替加环素的敏感率均为100%,对利奈唑胺的敏感率分别为98.3%和100%。按青霉素非脑膜炎株折点判读,肺炎链球菌中青霉素耐药株(PRSP)的比率为6.0%(14/232),其中5岁以下儿童中PRSP的比率为13.8%(9/65),65岁以上的老人中PRSP的发生率为5.1%(3/59);未发现对替考拉宁、万古霉素、利奈唑胺、替加环素耐药的肺炎链球菌。结论葡萄球菌中MRSA检出率在ICU患者中较门诊和住院患者高,MRSA主要分离自呼吸道标本和各种分泌物和脓液标本。万古霉素耐药的肠球菌在我国发生率低。PRSP在5岁以下儿童中的比率明显高于其他年龄组。替考拉宁、万古霉素、利奈唑胺、替加环素对葡萄球菌、粪肠球菌、屎肠球菌和肺炎链球菌具有很好的抗菌活性。

Surveillance of antimicrobial resistance in gram-positive cocci isolated from 12 teaching hospitals in China during the period from June to December 2010

Objective To investigate the antimicrobial resis tance among the gram-positive cocci isolated from 12 teaching hospitals in China. Methods From June 2010 to December 2010, l 181 strains of consecutive and nonduplicate gram positive cocci were collected from 12 teaching hospitals in 9 cities across China. The minimal inhibitory concentrations （MICs） of antibacterial agents were determined by agar dilu tion method and the rate of resistance was calculated. Results The prevalence of methicillin-resistant Staphylococcus aureus （MRSA） and coagulase-negative Staphylococcus was 40.6 % （191/470） and 79.6% （187/236）, respectively. The preva-lence of MRSA ranged from 22.2% to 72.7% in different specimens. The prevalence of MRSA in ICU was 71. 40/00, higher than that in general inpatients and outpatients. All staphylococcal isolates were susceptible to vancomycin,teicoplanin and linezolid. The MICs of tigecycline against these staphylococcal isolates were 0. 032 - 0. 5 mg/L. Ten strains of E. faecium and 2 strains of E. faecalis were resistant to vancomycin. All E. faecium and E. faecalis isolates were suscepti- ble to tigecycline. About 98.3% of E. faecalis strains and 100% of E. faecium strains were susceptible to linezolid. The prevalence of penicillin-resistant S. pneumoniae （PRSP） was 6.0% （14/232）. The prevalence of PRSP was 13.8% （9/65） in the strains isolated from children under 5, and 5. 1% （3/59） in the strains isolated from old people above 65. All S. pneumoni- ae strains were susceptible to teicoplanin, vancomycin, linezolid and tigecycline. Conclusions The prevalence of MRSA in ICU was higher than that in general inpatients and outpatients. MRSA strains were mainly from respiratory specimens and pus. Vancomycin-resistant Enterococcus was rarely identified, and most of the VRE strains were E. faeciurn. The prevalence of PRSP in the strains isolated from children under 5 was higher than in other age groups. Teicoplanin, vancomycin, linezolid, and tigecycline showed high in vitro activity against Staphylococcus, E. faecalis, E. Jaecium and Streptococcus pneumoniae.