2007年9家军队医院细菌分布与耐药监测分析

目的监测2007年不同地区军队医院患者血液、尿液、无菌体液标本中细菌分布及耐药情况。方法收集不重复临床分离菌1397株，经我院微生物科复核，采用琼脂稀释法测定抗菌药物对细菌的最低抑菌浓度（MIC），并检测超广谱β-内酰胺酶（ESBLs）。结果获得革兰阳性菌382株（27.3％），革兰阴性菌1015株（72．7％）。甲氧西林耐药金黄色葡萄球菌（MRSA）检出率为41．3％，MRSA除对万古霉素、替考拉宁、利奈唑胺和米诺环素保持较高敏感率（93．9％-100％）外，对其他药物的敏感率均低于13％。未发现万古霉素耐药的肠球菌（VRE）和葡萄球菌（VRSA）。肠杆菌科细菌对美罗培南和亚胺培南的敏感率最高f100％），而对环丙沙星的敏感率仅为12％左右；大肠埃希菌、克雷伯菌产ESBLs的比率分别为69．4％和61．8％。多重耐药的铜绿假单胞菌和不动杆菌分别占34．6％和60．2％。尿液中分离出的大肠埃希菌对环丙沙星和左氧氟沙星的耐药率分别高达89．6％和90．6％。结论MRSA、产ESBLs的肠杆菌、铜绿假单胞菌和不动杆菌仍是部队医院高耐药菌；细菌对喹诺酮类抗生素耐药性增高。

Distribution of bacteria and their drug resistance monitoring in 9 military hospitals of China in 2007

Objective To investigate the distribution of clinical isolates from blood, urine and other fluids and their drug resistance monitoring in 9 military hospitals of China in 2007. Methods A total of 1 397 non-repetitive clinical isolates were collected and sent to the Chinese PLA General Hospital for re-identification and susceptibility testing. A minimal inhibitory concentration （MIC） of antimicrobial agents and ESBL-producing bacteria were detected using the agar dilution method. WHONET5.4 software was used to analyze the data. Results Gram-positive cocci and Gram-negative bacilli accounted for 27.3% and 72.7% respectively of the 1 397 clinical isolates from blood, urine and other fluids. The detection rate of methicillin-resistant staphylococcus aureus （MRSA） was 41.3%. The susceptible rate of MRSA was lower than 13% to antimicrobial agents and 93.9%-100% to vancomycin, teicoplanin and minocycline, respectively. No isolate of Enterococci and Staphylococcus aureus was resistant to vancomycin. The susceptibility rate of meropenem and imipenem to ciprofloxacin was 100%, while that of Escherichia coli and Klebsiella spp to ciprofloxacin was only 12%. ESBL-producing strains accounted for 69.4% and 61.8% in Escherichia coli and Klebsiella spp, respectively. The multidrug resistance of P. aeruginosa （MDRPA） and Acinetobacter baumannii （MDRA） was 34.6% and 60.2%, respectively. The resistance of Escherichia coli isolated from urine to ciprofloxacin and levofloxacin was 89.6% and 90.6%, respectively. Conclusion The resistance levels in isolates of MRSA, ESBLs, MDRPA and MDRA to antimicrobial agents are high in military hospitals of China. The resistance of bacteria isolated from urine to fluorquinolone agents is increasing.