2006年中国CHINET细菌耐药性监测

目的了解国内主要地区医院临床分离菌对常用抗菌药物的耐药性。方法联合国内主要地区较有代表性的9所医院（7所综合性医院，2所儿童医院）按统一方案进行抗菌药物敏感试验，按CLSI 2006年版判断结果。结果2006年1月至12月各医院共33945株临床分离菌中，革兰阳性菌占31．8％，革兰阴性菌68．2％。558株肺炎链球菌中成人株（202株）中PSSP、PISP、PRSP分别为92．1％、5．4％和2．5％；儿童株（356株）中分别为11．8％、68．5％和19．7％。流感嗜血杆菌产酶率25％，金葡菌和凝固酶阴性葡萄球菌中耐甲氧西林株分别平均占58．4％和76．3％，但2所儿童医院的MRSA仅占12．4％和3．8％。葡萄球菌属中未发现对万古霉素、替考拉宁、利奈唑胺耐药株。粪肠球菌和屎肠球菌对高浓度庆大霉素的耐药率分别达51％和77％，发现12株对万古霉素耐药屎肠球菌，已证实其中11株属VanA型耐药。大肠埃希菌、克雷伯菌属和奇异变形杆菌中产ESBLs菌株检出率分别为51．7％、45．2％和18．1％，各种肠杆菌科细菌对亚胺培南和美罗培南均高度敏感，平均耐药率低于1％。铜绿假单胞菌和不动杆菌属对上述2种碳青霉烯类的耐药率均〉30％。多数医院的革兰阴性杆菌中均不同程度存在多重耐药株和泛耐药株。结论细菌耐药性仍呈增长趋势，尤其革兰阴性杆菌中出现的多重耐药株和泛耐药株，应引起各医院高度重视，采取有效措施，控制耐药茵在医院内播散和暴发流行。

CHINET 2006 surveillance of bacterial resistance in China

Objective To investigate the resistance of clinical isolates from hospitals in several regions of China, in 2006. Methods Eight general hospitals and two children＇s hospitals were involved in this program. Bacterial susceptibility testing was carried out according to an agreed protocol using Kirby-Bauer method. Results were analyzed according to CLSI 2006. Results A total of 33 945 clinical isolates were collected from January through December 2006, of which gram negative microorganisms and gram positive cocci accounted for 68. 2% and 31. 8% respectively. In the 202 strains of S. pneumonia from adults, 92.1%, 5.4%, 2.5% were identified as penicillin-susceptible （PSSP）, -intermediate （PISP） and -resistant （PRSP）, respectively. Of the 356 strains of S. pneumonia from children, 11.8%, 68.5%and 19.7% were PSSP, PISP and PRSP, respectively. Beta-lactamase production was positive in 25% of H. influenzae isolates. Methicillin resistant strains in S. aureus （MRSA） and MRCNS accounted for an average of 58.4% and 76.3% respectively. However, the prevalence of MRSA and MRCNS was only 12.4% and 3.8% respectively in the two children＇s hospitals. No staphylococcal isolate was found resistant to vancomycin, teicoplanin or linezolid. On average, 51% of E. faecalis and 71% of E. faeciurn strains were resistant to high concentration gentamicin （120 μg/disc）. Twelve vancomycin-resistant E. faecium （VRE） strains were isolated, 11 of which were van A type. About 51.7% （31%-67.4%） of E. coli, 45.2% （15.4%-67.9%） of Klebsiella spp. （K. pneumoniae and K. oxytoca）, and 18. 1% of P. rnirabilis isolates were ESBLs-producing strains. Isolates of Enterobacteriaceae were still highly sensitive to imipenem and meropenem. The average resistance rate was less than 1%. However, up to 30%-40% strains of P. aeruginosa and Acinetobacter spp. were resistant to the two carhapenems. Moreover, some multi-drug resistant and panresistant gram negative bacilli were found in these hospitals. Conclusions Bacterial res