深圳南山医院2010年细菌耐药性监测

目的了解某院2010年临床住院患者送检标本分离菌株对常用抗菌药物的耐药性。方法采用全自动细菌鉴定仪及配套鉴定与药物敏感试验试剂，检测临床分离菌对常用抗菌药物的耐药性，并用WHONET5.4软件进行统计分析。结果2010年1-12月共分离病原菌2 192株，其中革兰阳性菌占32.03%，革兰阴性菌占67.97%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中，甲氧西林耐药株(MRSA 和 MRCNS)分别占 19.69%和54.59%。葡萄球菌属中耐甲氧西林株对β 内酰胺类抗生素和其他测试抗菌药物的耐药率显著高于甲氧西林敏感株。 MRSA对复方磺胺甲口恶唑、利福平、四环素、庆大霉素的耐药率分别为1.67%、41.54%、44.62%、58.46%；MRCNS对利福平、四环素的耐药率分别为17.27%和36.70%；未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中，粪肠球菌对大多数测试抗菌药物的耐药率低于屎肠球菌；此次监测首次在该院发现1株耐利奈唑胺的粪肠球菌，未发现耐万古霉素菌株。大肠埃希菌、肺炎克雷伯菌中产超广谱β 内酰胺酶(ESBLs)株分别为 44.29%和 15.79%。肠杆菌科细菌中产ESBLs株对抗菌药物的耐药率均比非产ESBLs株高。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为 26.73%和13.79%，不动杆菌属(鲍曼不动杆菌占92.91%) 对二者的耐药率分别为31.35%和 27.17%。结论细菌耐药性仍呈增长趋势, 尤其革兰阴性杆菌；鲍曼不动杆菌及铜绿假单胞菌对碳青霉烯类抗生素耐药性的增加，对临床构成严重威胁。合理选用抗菌药物，及早检测泛耐药菌, 加强感染控制措施是当务之急。

Surveillance on bacterial resistance in Shenzhen Nanshan Hospital in 2010

Objective To investigate the resistance of clinical bacterial isolates from a hospitals in 2010.Methods Antimicrobial susceptibility of bacterial isolates from inpatients was detected by BD-automatic identification of bacterial analyzer,and data were analyzed with WHONET5.4 software.Results A total of 2 192 pathogenic strains were isolated from various clinical specimens from January to December,2010,67.97% of which was gram-negative bacilli and 32.03% was gram-positive cocci.19.69% of Staphylococcus aureus and 54.59% of coagulase negative Staphylococcus was methicillin-resistant（MRSA and MRCNS respectively）.The resistant rates of methicillin-resistant strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-sensitive strains.The resistant rate of MRSA to sulfamethoxazole/trimethoprim,rifampin,tetracycline,and gentamicin was 1.67%,41.54%,44.62%,and 58.46%,respectively,the resistant rates of MRCNS to rifampin and tetracycline was 17.27% and 36.70%,respectively;vancomycin-,teicoplanin-and linezolid-resistant strain was not found.The resistant rates of Enterococcus faecalis to most detected antimicrobial agents were much lower than those of Enterococcus faecium.One linezolid-resistant Enterococcus faecalis isolate was first reported in this hospital,vancomycin-resistant strain was not found.Extended-spectrum β-lactamase（ESBL）-producing strains accounted for 44.29% of Escherichia coli and 15.79% of Klebsiella pneumoniae.Resistant rates of ESBL-producing Enterobacteriaceae strains were higher than non-ESBL-producing Enterobacteriaceae strains.Resistant rate of Pseudomonas aeruginosa to imipenem and meropenem was 26.73% and 13.79%,respectively,resistant rate of Acinetobacter spp.（92.91% were Acinetobacter baumannii） to above two carbapenems was 31.35% and 27.17%,respectively.Conclusion Bacterial resistance is on the rise,especially drug resistance of gram-negative bacilli;resistance of Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenems is increasing.It is important to use antimicrobial agents rationally,detect pandrug-resistant strains early,and strengthen infection control.