2005年上海地区细菌耐药性监测

目的了解上海地区14所医院临床分离株对抗菌药物的耐药情况。方法采用纸片扩散法（K—B法）对30635株临床分离株进行药敏试验。结果30635株临床分离株中革兰阳性菌占34．7％，革兰阴性菌占65．3％。MRSA和MRCNS的检出率分别为65．6％和82．2％。青霉素敏感肺炎链球菌（PSSP）成人患者和儿童患者中的检出率分别为81．8％和28．0％，青霉素不敏感株的检出率分别为18．2％（PISP18．2％和PRSP0）和72．0％（PISP51．4％和PRSP20．1％）。发现3株万古霉素耐药的屎肠球菌，2株为wanA基因、1株为wanB基因。未发现VRSA或VISA株。产ESBLS的大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌的检出率分别为39．8％、44．3％和11．5％。亚胺培南和美罗培南对肠杆菌科细菌和不动杆菌属的抗菌活性最强。结论MRSA和MRCNS仍然是目前革兰阳性菌中主要的问题；未发现VISA和VRSA，但发现了3株万古霉素耐药屎肠球菌。出现少数铜绿假单胞菌（3．41％）和鲍曼不动杆菌（6．47％）泛耐药株。对临床分离株的耐药情况应进行流行病学调查及采取相应控制措施。

Surveillance of bacterial resistance in hospitals of Shanghai during 2005

Objective To investigate the antibiotic resistance of clinical isolates in 14 Shanghai hospitals from January to Decem- ber of 2005.Methods Antimicrobiai susceptibility testing of 30 635 clinical isolates were carried out by means of Kirby Bauer (KB)method.Results Of 30 635 clinical isolates,gram negative bacilli and gram positive cocci accounted for 65.3% and 34.7% respectively.MRSA was detected in 65.6% of S.aureus isolates,and MRCNS was identified in 82.2% of coagulase negative Staphylococcus isolates.About 81.8% and 28.0% of the S.pneumoniae isolates from adults and children were peni- cillin-susceptible S.pneumoniae(PSSP).Penicillin-nonsusceptible S.pneumoniae(PISPT PRSP)strains accounted for 72. 0%(PISP 51.7% and PRSP 20.3%)in children strains,but 18.2%(PISP 18.2% and PRSP 0)in adult strains.Three strains of VRE were found in E.faecium,one being van B type,the other two being van A type.No VISA or VRSA strain was identified.ESBLs-producing strains accounted for 39.8%,44.3% and 11.5% in E.coli,Klebsiella spp.and P.mirabi- lis,respectively.Imipenem and meropenem were the most active agents against strains of Enterobacteriaceae and Acinetobacter spp..Conclusions Methicillin-resistant staphylococcus(MRSA and MRCNS)is still the major problem in gram-positive cocci. Three strains of VRE were found.No VISA or VRSA strain was identified.Some pandrug-resistant isolates of P.aeruginosa (3.41%)and A.baumannii(6.47%)are emerging.It is urgently needed to conduct epidemiological investigation and take measures to control its nosocomial spread.