2011年第四季度天津市细菌耐药性监测

目的 建立天津市细菌耐药监测网(TJARSN),了解天津市细菌耐药现状,为卫生行政部门制定抗菌药物政策,指导临床抗菌药物合理应用提供依据.方法 选择天津市有代表性的22所三级和区县级医院,药敏测定采用自动化方法,收集2011年第四季度临床分离细菌情况,以WHONET5.4软件进行数据分析,药敏判断采用CLSI 2008年标准.结果 共分离细菌15880株,革兰阳性菌4376株占27.6％,葡萄球菌属为主要菌属,共分离出2724株占62.2％；肠球菌属997株占22.8％;链球菌属575株占13.1％；革兰阴性菌11 504株占72.4％,排第1位是肺炎克雷伯菌2507株占21.8％,其后依次为大肠埃希菌、铜绿假单胞菌,分别为占21.6％、14.2％；耐甲氧西林金黄色葡萄球菌( MRSA)与耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为38.8％和71.1％；非颅内感染肺炎链球菌对青霉素不敏感率成人(18.7％)低于儿童(43.8％),对左氧氟沙星耐药率成人与儿童均＜5.0％,对大环内酯类耐药率为85.3％～99.1％,对万古霉素无耐药；肠球菌属中已出现对糖肽类耐药株,粪肠球菌和屎肠球菌对万古霉素耐药率分别为0.4％和3.6％,对替考拉宁的耐药率分别为1.1％和4.6％；大肠埃希菌对喹诺酮类药物耐药率约53.0％,大肠埃希菌、肺炎克雷伯菌产超广谱β内酰胺酶检出率分别为34.4％和19.7％,肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感,总耐药率＜1.0％；铜绿假单胞菌和鲍氏不动杆菌对亚胺培南和美罗培南耐药率分别为20.1％和18.6％、18.9％和19.9％.结论 初步建立了天津市细菌耐药监测网,以了解天津市临床分离菌株及细菌耐药现状；细菌耐药呈增长趋势,细菌耐药监测工作应引起足够的重视.

Surveillance of bacterial resistance in Tianjin of the fourth quarter of 2011

OBJECTIVE To establish a level bacterial resistance surveillance network in Tianjin and get information about bacterial resistance for assisting the clinical use of antibacterials and providing objective material in administration of antibacterials.METHODS Twenty-two hospitals in Tianjin were involved in this program.Bacterial susceptibility testing was carried out with automatic microbiological system method.All the bacterial susceptibility results of the fourth quarter of 2011 were processed with WHONET5.4 software and analyzed according to CLSI 2008 breakpoints.RESULTS A total of 15 880 bacterial isolates and their antibacterial susceptibility data were collected,which included 4376(27.6%) strains of gram-positive bacteria and 11 504(72.4%) strains of gram-negative bacteria.Staphylococcus(2724 strains),Enterococcus(997 strains) and Streptococcus(575 strains) were the most common gram-positive isolates.Klebsiella pneumoniae(2507 strains),Escherichia coli(2490 strains) and Pseudomonas aeruginosa(1637 strains) were the top three gram-negative isolates,accounting for 21.8%,21.6%,and 14.2%,respectively.The detection rates of methicillin-resistant S.aureus(MRSA) and methicillin-resistant coagulase-negative Staphylococcus(MRCNS) were 38.8% and 71.1%.Regarding non-meningitis S.pneumoniae strains,the rate of penicillin non-susceptible in adults(18.7%) was lower than that in the children′s(43.8%).Glycopeptides-resistant Enterococcus were detected.The drug resistance rates of E.faecalis and E.faecium to vancomycin were 0.4% and 3.6%,respectively,the drug resistance rates to teicoplanin were 1.1% and 4.6%,respectively.Quinolone-resistant E.coli was about 53%.The prevalence of ESBLs-producing strains was 34.4% in E.coli and 19.7% in K.pneumoniae.The Enterobacteriaceae strainswere still highly susceptible to carbapenems.Overall less than 1% of these strains were resistant to carbapenems.About 20.1% and 18.6% ofP.aeruginosa strains were resistant to imipenem and meropenem.18.9% and 19.9%A.baumannii strains were resistant to imipenem and meropenem. CONCLUSION The bacterial resistance surveillance network in Tianjin is established so as to understand the current status of bacterial resistance of clinical isolates in Tianjin.The bacterial resistance keeps an upward tendency,which should be attached great importance.