2012年中国CHINET无菌体液中分离的细菌构成和耐药性监测

目的：了解国内不同地区15所医院2012年从临床分离自脑脊液及其他无菌体液（胸水、腹水、胆汁等）的细菌构成及其对抗菌药物的耐药性。方法对国内主要地区（13所综合性医院、2所儿童医院）临床分离菌株采用纸片扩散法或自动化仪器法按统一方案进行细菌药敏试验，按CLSI 2012版标准判断结果。结果3945株非重复的细菌中，革兰阴性菌2214株，占56．1％，革兰阳性菌1731株，占43．9％。无菌体液中最常见的细菌依次为大肠埃希菌，肺炎克雷伯菌，凝固酶阴性葡萄球菌（CNS），屎肠球菌，粪肠球菌。无菌体液标本中甲氧西林耐药金黄色葡萄球菌（金葡菌）和CNS（MRSA和MRCNS）的检出率分别为61．3％和77．2％。未发现对万古霉素、利奈唑胺耐药的葡萄球菌。无菌体液中发现1株对万古霉素耐药的粪肠球菌和1株对利奈唑胺耐药的粪肠球菌，还发现6株对万古霉素耐药的屎肠球菌。无菌体液标本中产ESBL大肠埃希菌和肺炎克雷伯菌的检出率分别为48．1％和24．4％。无菌体液标本中泛耐药鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌的检出率分别为24．5％、5．5％和1．4％。结论应防范泛耐药肠杆菌科细菌和鲍曼不动杆菌对临床造成严重威胁。

The distribution and antibioic resistance of the bacterial strains isolated from sterile body fluids in 2012 CHINET Surveillance Program

Objective To investigate the distribution and antimicrobial resistance of the bacterial strains isolated from cerebrospinal fluid and other sterile body fluids in 15 teaching hospitals across China during 2012 CHINET Surveillance Program . Methods Thirteen general hospitals and two children′s hospitals were involved in this program . Antimicrobial susceptibility testing was carried out according＆ to a unified protocol using Kirby‐Bauer method or automated systems .Results were analyzed according to the breakpoints of CLSI 2012 .Results A total 3 945 nonduplicate clinical isolates were collected from January to December in 2012 ,of which gram negative organisms and gram positive cocci accounted for 56 .1% and 43 .9% ,respectively .E .coli ,K .pneumoniae ,coagulase negative Staphylococcus （CNS） ,E .faecium and E .f aecalis were the most common bacterial isolates from sterile body fluids . Generally ,61 .3% of the S . aureus isolates and 77 .2% of the CNS isolates from sterile body fluids were resistant to methicillin .No staphylococcal strain was resistant to vancomycin or linezolid .One strain of E . f aecalis isolated from sterile body fluid was found resistant to vancomycin and one strain of E . f aecalis was found resistant to linezolid .Six E . f aecium strains were found resistant to vancomycin .ESBLs production was found in 48 .1% of the E .coli strains and 24 .4% of the K . pneumoniae strains isolated from sterile body fluid .Pan‐resistant strains were identified in the A .baumannii （24 .5% ） , K . pneumoniae （5 .5% ） and P .aeruginosa （1 .4% ） strains isolated from sterile body fluid .Conclusions More attention should be paid to the challenge of pan‐resistant Enterobacteriaceae and A .baumannii .