2008—2011年北京协和医院重症监护病房细菌耐药性监测

  目的  了解重症监护病房病原菌分布及其耐药情况。  方法  2008年1月至2011年12月间北京协和医院重症监护病房患者中连续分离到3507株非重复细菌, 采用纸片扩散法对临床分离菌株进行药敏试验, 按美国临床实验室标准化研究所2011年标准判读药敏结果, 采用WHONET 5.4软件分析数据。  结果  3507株非重复细菌中, 革兰阴性菌占74.7%, 革兰阳性菌占25.3%。10种最常见的细菌分别为:鲍曼不动杆菌(28.1%)、铜绿假单胞菌(12.8%)、金黄色葡萄球菌(10.0%)、大肠埃希菌(7.8%)、肺炎克雷伯菌(7.7%)、凝固酶阴性葡萄球菌(7.1%)、嗜麦芽窄食单胞菌(5.2%)、屎肠球菌(4.4%)、阴沟肠杆菌(2.3%)、粪肠球菌(2.3%)。4年中耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulasenegative staphylococci, MRCNS)的总检出率分别为74.9%(262/350)和83.4%(206/247), MRSA中有82.6%的菌株对磺胺甲噁唑-甲氧苄啶敏感, MRCNS中有79.6%的菌株对利福平敏感。均未发现对万古霉素、替考拉宁和利奈唑胺耐药的菌株。粪肠球菌对氨苄西林(18.2%)、呋喃妥因(5.6%)和磷霉素(2.7%)的耐药率较低, 屎肠球菌对万古霉素和替考拉宁的耐药率分别为9.5%和7.5%, 粪肠球菌对二者的耐药率分别为1.3%和1.3%。产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的总检出率分别为60.2%(165/274)和46.8%(126/269)。鲍曼不动杆菌泛耐药株(除外米诺环素)的总检出率为60.4%(596/987), 铜绿假单胞菌泛耐药株的总检出率为5.6%(25/450)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为82.8%和83.8%, 对米诺环素的敏感率为58.0%。铜绿假单胞菌对阿米卡星的耐药率最低, 为16.8%, 对亚胺培南和美罗培南的耐药率分别为42.6%和35.3%。  结论  在重症监护病房, 碳青霉烯类抗生素对大肠埃希菌和肺炎克雷伯菌仍保持高活性, 鲍曼不动杆菌耐药性呈增长趋势, 特别是多重耐药和泛耐药菌株。

2008--2011 Surveillance of Resistance in Bacteria Isolated from Intensive Care Units in Peking Union Medical College Hospital

Objective To investigate the rates of resistance in bacteria obtained from intensive care units （ICU） in Peking Union Medical College Hospital. Methods A total of 3507 non-duplicate clinical isolates from ICU were collected from January 2008 to December 2011. Disc diffusion test （Kirby-Bauer method） was employed to study the antimicrobial resistance. The data were analyzed by WHONET 5.4 software according to Clinical and Laboratory Standards Institute （CLSI） 2011 breakpoints. Results Among these 3507 non-duplicate clinical isolates, gram-negative organisms and gram-positive cocci accounted for 74.7% and 25.3% , respectively. The 10 most common pathogens in ICU were A. baumannii （28.1%）, P. aeruginosa （12.8%）, S. aureus （ 10.0% ） , E. coli （ 7.8% ） , K. pneumoniae （ 7.7% ） , coagulase-negative staphylococci （7. 1% ）, S. maltophilia （5.2%）, E. faecium （4.4%）, E. cloacae （2.3%）, and E. faecalis （2.3%）. Methicillin-resistant Staphylococcus aureus （MRSA） strains and coagulase-negative staphylococci （MRCNS） accounted for 74.9% （262/350） and 83.4% （206/247） , respectively. However, 82.6% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 79.6% of MRCNS strains were susceptible to rifampin. No staphylococcal strain was resistant to vancomycin, teicoplanin, or linezolid. The resistance rates of faecalis to ampicillin （ 18.2% ） , nitrofurantoin （5.6%）, and fosfomycin （2.7%） were low. The resistant rates of E. faecium and E. faecalis to vancomycin were 9.5 % and 1.3 % , while to teicoplanin were 7.5 % and 1.3%, respectively. Extended spectrum [3-1actamases （ESBLs）-producing strains accounted for 60.2% （165/274） and 46.8% （126/269） in E. coli and K. pneumoniae, respectively. The rates of pan-resistant （except minocycline） A. baumannii and P. aeruginosa were 60.4% （596/987） and 5.6% （25/450）. The resistance rates ofA. baumannii to imipenem and meropenem were 82.8% and 83.8% , respectively. The susceptible rate to minocycline was 58.0%. The resistance rates of P. aeruginosa to imipenem and meropenem were 42.6% and 35.3% , respectively. P. aeruginosa isolates showed the lowest resistant rate （ 16.8% ） to amikacin. Conclusion Carbapenems remain highly active against E. coli and K. pneumoniae. The antibiotic resistance of A. baumanii is increasing, especially those multidrug-resistant and pandrug-resistant strains.