中国细菌耐药监测研究

目的 了解我国不同地区院内感染（HI）和社区获得感染（CAI）病人中致病菌的耐趋势。方法 按1998年美国临床实验标准委员会指导原则采用标准的平甲稀释法，对1998－1999年从13家医院分离的2081株致病菌进行敏感试验。以MIC50、MIC90表示抗菌药物的抗菌活性，R％、I％、S％代表细菌对所测药物的耐药率、中介率与敏感率。结果 从CAI与HI病人中分别分离到金黄色葡萄球菌87株与11析，共98株。甲氧西林耐药金黄色葡萄球菌（MRSA）检出率为27.55%(27/98)，HI病人中MRSA检出率为81.82%(9/11)，显著高于CAI病人的MRSA检出率21.84（19／87）。青霉素耐药肺炎链球菌（PRSP）的检出率（R％＋I％）为22.50%(9/40)，其中R（MIC≥2mg/L)仅为2.5％（1／40），I占20％（8／40）。未发现万古霉素耐药金黄色葡萄球菌和万古霉素耐药肠球菌（VRE），万古霉素中介粪肠球菌和屎肠球菌分别为3.23%(9/279)和3.77%(2/53)。大肠杆菌对各种喹诺酮类呈交叉耐药，耐药率超过60％。结论 中国也存在严重的多重耐药问题，如多重耐药的MRSA、PRSP、肠杆菌属等，特别是大肠杆菌对喹酮类的耐药率，是全世界迄今为止报告的最高耐药率。

Surveillance of bacterial resistance in China (1998-1999)

OBJECTIVE: To determine the rates of bacterial resistance of clinical isolates obtained from patients with hospital infections (HI) or community acquired infections (CAI) in the study wards of 13 hospitals located at different areas in China. METHODS: Susceptibility test was performed on 2 081 strains isolated from 13 hospitals, using standard plate dilution method according to the guidelines of NCCLS (1998). MIC(50) and MIC(90) were used to show the antibacterial activity of antimicrobial agents, and data of R%, I% and S% represent resistant, intermediate and susceptible rates of bacteria to antimicrobial agents tested. RESULTS: Among total 98 strains of S. aureus, 87 were isolated from patients with CAI and 11 were from HI patients. The incidence of methicillin resistant S.aureus (MRSA) from total infections caused by S. aureus was 27.55%, while the incidence of MRSA from HI patients was 81.82%, which was significantly higher than that (21.84%) from CAI patients. The rate of penicillin resistant S. pneumoniae (PRSP) (R% + I%) was 22.50%; the rate of R (MIC >/= 2 mg/L) was 2.5%, and most of PRSP strains was intermediate, with I% of 20%. No strains of S. aureus, neither strains of E. faecalis, nor of E. faecium were found resistant to vancomycin. The intermediate rate (I%) of E. faecalis and E. faecium to vancomycin was 3.23% and 3.77%, respectively. Cross resistance of E. coli to quinolones was present obviously, and more than 60% of E. coli strains were resistant to fluoroquinolones tested. CONCLUSION: Multi-drug resistance (MDR) of bacteria is a serious problem in China, including MDR of MRSA, PRSP, and enterobacteriaceae; and the resistant rate of enterobacterinceae is the highest up-to-date.