苏州大学附属第一医院2010～2011年细菌耐药性监测分析

目的分析苏州大学附属第一医院2010和2011年临床分离细菌对抗菌药物的耐药性。方法采用Kirby-Bauer(K-B)法对临床分离菌进行药敏试验,结果按CLSI 2010年版标准判断并采用WHONET 5.5软件进行数据分析。结果两年共分离细菌12 991株,其中革兰阳性菌3 100株(24.0%),革兰阴性菌9 891株(76.0%)。MRSA和MRCNS检出率分别为65.3%(581/889)和89.7%(979/1 091),未检测到万古霉素、利奈唑胺耐药株,粪肠球菌和屎肠球菌对万古霉素的耐药率分别为1.5%和4.3%。2010年大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌的产ESBLs率分别为67.0%、49.0%和30.0%,2011年则分别为66.1%、54.6%和37.6%。肠杆菌科细菌对亚胺培南仍保持较高的敏感率(>96%)。鲍曼不动杆菌的耐药率很高,仅对头孢哌酮/舒巴坦耐药率较低,为36.7%,亚胺培南耐药率>70%。铜绿假单胞菌对阿米卡星耐药率最低,为16.8%,其次是环丙沙星和头孢哌酮/舒巴坦(20.3%和20.8%),对亚胺培南耐药率为39.7%。结论 2010～2011年我院分离的细菌以阴性杆菌为主,细菌多重耐药性严重,万古霉素耐药肠球菌和碳青霉烯类抗生素耐药肺炎克雷伯菌有增多趋势,应引起重视。

Surveillance of bacterial resistance in clinical isolates in first affiliated hospi- tal of Suzhou university from 2010 to 2011

Objective To investigate the resistance of clinical isolates in our hospital from 2010 to 2011. Methods Antimi- crobial susceptibility testing was carried out by means of K-B, and the results were analyzed by WHONET 5.5 according to CLSI 2010 breakpoints. Results Of 12 991 clinical isolates,24.0% was gram-positive cocci and 76.0% was gram-nega- tive bacilli. The detection rates of MRSA and MRCNS were 65.3% and 89.7%, respectively. No vancomycin or linezolid re- sistant isolate was found in Staphylococcus, and the resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin were 1.5% and 4.3%, respectively. The prevalence of ESBLs was 67.0% in Escherichia.coli, 49.0% in Kleb- siella pneumonia and 30.0% in Proteus mirabilis in 2010. Imipenem was the most potent antimicrobial agent against Enter- obacteriaceae （〉96%）. The isolation of mutiple-drug-resistant Acinetobacter baumannii was serious, the resistant rate to ce- foperazone/sulbactum was 36.7%, the resistant rate to imipenem was over 70%. The most active agent against Pseudomonas aerugionsa was amikacin （resistant rate was 16.8%）, followed by ciprofloxacin （20.3%） and cefoperazone/sulbactum （20.8%）, the resistant rate to imipenem was 39.7%. Conclusion Most clinical isolates from 2010 to 2011 were Gram-negative bacilli. The antimicrobial resistance of common pathogenic bacterial was serious, especially the prevalence of vancomycin-resistant Enterococcus and carbapenems-resistant Klebsiella pneumoniae were increasing, which should be noted.