全国医院感染监控网细菌耐药情况及变化趋势 FREE

目的探讨医院感染细菌的耐药情况及变化趋势。方法对1999年1月-2007年12月全国医院感染监控网各监测医院报告的细菌耐药结果进行统计分析。结果在革兰阳性（G+）菌中，葡萄球菌属、肠球菌属细菌对万古霉素最敏感，敏感率＞96%；耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林表皮葡萄球菌（MRSE）、耐甲氧西林溶血葡萄球菌（MRSH）的检出率分别为80.18%、77.19%和90.71%，耐青霉素肺炎链球菌（PRSP）的检出率为43.84%；粪肠球菌、屎肠球菌对氨苄西林的耐药率分别为30.15%、81.60%。在革兰阴性（G-）杆菌中，肠杆菌科常见菌属对抗菌药物的敏感性以美罗培南最高，达89%以上，其次为亚胺培南（88%）；G-非发酵菌假单胞菌属、不动杆菌属、窄食单胞菌属对头孢哌酮/舒巴坦耐药率最低，分别为28.86%、18.53%和20.85%，前二者对亚胺培南的耐药率分别为33.81%和22.86%。常见G-菌对哌拉西林/他唑巴坦与哌拉西林、头孢哌酮/舒巴坦与头孢哌酮的耐药率相比，明显下降（P＜0.05）。2005年1月-2007年12月与1999年1月-2001年12月相比，耐药率上升30%以上的有：表皮葡萄球菌对亚胺培南，粪肠球菌对哌拉西林，屎肠球菌对青霉素、阿莫西林/克拉维酸，大肠埃希菌对头孢吡肟，铜绿假单胞菌对替卡西林/克拉维酸，鲍曼不动杆菌对氨苄西林/舒巴坦、阿莫西林/克拉维酸、亚胺培南，嗜麦芽窄食单胞菌对氨苄西林/舒巴坦。耐药率上升最快的细菌是鲍曼不动杆菌，耐药率上升最快的抗菌药物种类是第三代头孢菌素。结论医院感染菌株耐药率高，且绝大多数呈现多重耐药；对同一抗生素加酶抑制剂者比未加者敏感；耐药率整体呈上升趋势，尤其为鲍曼不动杆菌和第三代头孢菌素。

Antimicrobial resistance of bacteria and changing trend in China Nosocomial Infection Surveillance System FREE

Objective To evaluate antimicrobial resistance of bacteria in nosocomial infection （NI） and changing trend. Methods Antimicrobial resistant results of bacteria reported to China Nosoeomial Infection Surveillance System （CNISS） by national wide hospitals between January, 1999 and December 2007 were analyzed statistically. Results Among gram-positive bacteria, Staphylococcus and Enterococcus were the most sensitive bacteria to vancomycin, sensitive rate was more than 96%; the detection rate of methieillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epiderrnidis , methicillin-resistant Staphylococcus haemol yticus , penicillin-resistant Streptococcus pneurnoniae was 80. 18%, 77. 19%, 90. 71% and 43.84% respectively; the resistant rate of Enterococcus faecalis and Enterococcus faecium to ampicillin was 30. 15% and 81.61）% respectively. Among gram-negative bacilli, the common bacteria in Enterobacteriaeeae were most sensitive to meropenem, which was more than 89%, the next was imipenem（88%） ; the resistant rates of non-fermentative bacteria including Pseudomonas spp. , Acinetobacterspp. , and Stenotrophornonas spp. to cefoperazone/sulbactam was the lowest, which was 28. 86%, 18.53 % and 20. 85 % respectively, the resistant rate of Pseudornonas spp. and Acinetobacter spp. to imipenem was 33.81 %and 22. 86% respectively. Compared with resistant rate to piperacillin and cefoperazone, the resistant rate of common gram-negative bacteria to piperacillin/tazobactam and cefoperazone/sulbactam decreased markedly （P〈0. 05）. Comparison among drug-resistant rates from January, 2005 - December, 2007 and January, 1999 - December, 2001 showed that drug-resistant rates of bacteria increased 300/oo were as follows： Staphylococcus epiderrnidis to imipenem, Enterococcus faecalis to piperacillin, Enterococcus faecium to penicillin and amoxicillin/clavulanate, Escherichia coli to cefepime, Pseudomonas aeruginosa to ticarcillin/elavulanate, Acinetobacter baumannii to ampicillin/sulbactam, amoxieillin/clavulanate and imipenem, Stenotrophmonas maltophilia to ampicillin/sulbactam. Drug-resistance increased most rapidly was Acinetobacter baumannii, and resistance to the third generation cephalosporins increased most rapidly. Conclusion Drug-resistant rate in NI is high, and most are multiple drug-resistance; antimicrobial agents with enzyme-inhibitors are more sensitive than non- enzyme-inhibitors; the resistance has tendency of increasing, especially Acinetobacterbaumannii and the third generation cephalosporins.