2010年中国CHINET铜绿假单胞菌耐药性监测

目的了解2010年我国不同地区铜绿假单胞菌临床分离株的耐药性和耐药特征,指导临床合理使用抗菌药物。方法对全国14所医院临床分离的5 080株铜绿假单胞菌按照统一的方案,采用统一的材料、方法(K-B法)和判断标准(CLSI 2010年版),进行铜绿假单胞菌的耐药性监测,并用WHONET5.4软件进行数据分析。结果 2010年14所医院共收集5 080株临床分离的铜绿假单胞菌,其中91.2%分离自住院患者;69.9%分离自呼吸道标本。铜绿假单胞菌对阿米卡星的耐药率最低,平均为15.3%,对其他抗菌药物的耐药率均高于18%。昆明一医院的分离株对各种抗菌药物的耐药率均高于28%,对其中13种抗菌药物的耐药率是14所医院中最高者;北京一医院分离的菌株对大多数抗菌药物的耐药率在40%左右,甘肃省一医院的分离株对抗菌药物(除头孢哌酮和氨曲南外)耐药率均低于20%;上海一儿童医院的分离株对各抗菌药物的耐药率均低于5%。从ICU分离菌对各种抗菌药物的耐药率均高于门诊、内科、外科和整体分离菌的耐药率(P=0.001)。各医院泛耐药铜绿假单胞菌的检出率平均为1.7%。结论我国临床分离的铜绿假单胞菌对常用抗菌药物的耐药性仍处于较高水平,但本次有轻微下降趋势。不同地区、不同医院的分离株对抗菌药物的耐药性相差较大,ICU仍应是监控重点。医疗机构应加强细菌耐药监测,指导临床合理使用抗菌药物。同时要加强感染控制措施,预防和控制耐药菌株的医院内流行。

CHINET 2010 surveillance of antimicrobial resistance in Pseudomonas aeruginosa

Objective To investigate the antimicrobial resistance of P.aeruginosa in China during 2010.Methods Clinical isolates of P.aeruginosa were collected from 14 teaching hospitals in China.The antimicrobial susceptibility were tested by Kirby-Bauer method and MIC determination.The data were analyzed by WHONET 5.4 software.Results Of the 5 080 clinical strains of P.aeruginosa,91.2% were isolated from hospitalized patients,and 69.9% were isolated from respiratory tract.These P.aeruginosa isolates showed the lowest resistance rate(15.3%) to amikacin.The percentage of the P.aeruginosa isolates resistant to other antimicrobial agents was generally above 18%.The P.aeruginosa strains collected from Kunming Hospital showed the highest resistance rate to 13 of the 14 antimicrobial agents compared with the strains from other hospitals.More than 28% of the isolates from Kunming Hospital were resistant to any of the antimicrobial agents tested.More than 40% of the strains isolated from a Beijing hospital were resistant to most of the antimicrobial agents tested.The isolates collected from a hospital in Gansu Province were less resistant(<20%) to any of the antibiotics except cefoperazone and aztreonam.For the strains from Shanghai Children’s Hospital,the resistance rate to any of the antimicrobial agents was lower than 5%.The resistance of P.aeruginosa strains from ICU was significantly higher than the resistance of the strains as a whole.The panresistant(only sensitive to colistin) P.aeruginosa strains accounted for 1.7% on average.Conclusions The antimicrobial resistance of P.aeruginosa is still a serious problem in China,but shows slight downward trend.The antimicrobial susceptibility pattern varied greatly with the hospital,and geographical region.ICUs are the focus of interest for resistance monitoring and control.The surveillance of antimicrobial resistance is very important for guiding rational antimicrobial therapy in healthcare facilities.