2011—2012年安徽省立儿童医院细菌耐药性监测

目的了解2011-2012年安徽省立儿童医院临床分离病原菌对常用抗菌药物的耐药性。方法采用K B纸片扩散法对该院临床分离的病原菌进行药敏试验。结果共检出病原体3 946株，革兰阳性菌、革兰阴性菌、真菌、支原体各占43.92%、37.91%、15.91%、2.26%。居病原体首位的为大肠埃希菌（16.32%），其次为肺炎链球菌（16.02%）、金黄色葡萄球菌（9.00%）、肺炎克雷伯菌（7.40%）等。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的41.41%（147/355）、81.40%（197/242）；大肠埃希菌、肺炎克雷伯菌产超广谱β 内酰胺酶（ESBLs）率分别为68.17％（439/644）、72.95％（213/292）。肺炎链球菌对红霉素（99.84%）、克林霉素（98.58%）高度耐药；MRSA对克林霉素、红霉素的耐药率较高（＞75%），MRSA和MRCNS对万古霉素、替考拉宁和利奈唑胺敏感率均为100.00%；屎肠球菌对万古霉素耐药率为98.31%；鲍曼不动杆菌除对头孢哌酮/舒巴坦耐药率（8.70%）较低，对其他抗菌药物耐药率均较高；铜绿假单胞菌耐药率较低的抗菌药物有亚胺培南、美罗培南、头孢他啶、阿米卡星和环丙沙星（＜26%）。检出4株对碳青霉烯类药物耐药的产ESBLs肺炎克雷伯菌，15 株泛耐药鲍曼不动杆菌。结论定期进行细菌耐药性监测，有助于了解医院细菌耐药变迁，为临床经验用药提供依据。

Surveillance of antimicrobial resistance in Anhui Provincial Children’s Hospital during 2011-2012

Objective To investigate the resistance of clinical bacterial isolates to commonly used antimicrobial a- gents in a hospital during 2011 - 2012. Methods Antimicrobial susceptibility testing of clinically isolated pathogens was performed by Kirby-Bauer method. Results A total of 3 946 pathogenic isolates were detected, gram-positive bacteria, gram-negative bacteria, fungi and mycoplasma accounted for 43.92%, 37. 91%, 15.91%, and 2. 26o/00 re- spectively. The top one isolate was Escherichia coli（ 16. 32 % ）, followed by Streptococcus pneumoniae （16. 02 %）, Staphylococcus aureus （9. 00%）, and Klebsiella pneumoniae （7. 40%） and so on. Methicillin-resistant Staphylo- coccus aureus （MRSA） and methicillin-resistant coagulase-negative staphylococcus （MRCNS） respectively accounted for 41.41% （147/355） of Staphylococcus aureus and 81.40% （197/242） of coagulase-negative staphylococcus extended-spectrum β-lactamase-producing rate of Escherichia coli and Klebsiella pneumoniae was 68. 17 % （439/644） and 72. 95% （213/292）respectively. The resistant rate of Streptococcus pneumoniae to erythromycin and clindamy- cin was 99. 84% and 98. 58% respectively; the resistance rate of MRSA to clindamycin and erythromycin was higher （〉75 %）, the resistance rates of MRSA and MRCNS to vancomycin, teicoplanin and linezolid were all 100. 00% ;the resistance rate of Enterococcus faecium to vancomycin was 98. 31 ~ ~ the resistance rate of Acinetobacter baurnannii to cefoperazone/sulbactam was low（8.70~）, while to the other antimicrobial agents were all high~ the resistance rate of Pseudomonas aeruginosa to imipenem, meropenem, ce{tazidime, amikacin and ciprofloxacin were all low （〈26%）. Four carbapenem-resistant ESBL-producing Klebsiella pneumoniae isolates and 15 pandrug-resistant Acinetobacter baumannii were detected. Conclusion Regular monitor on drug resistance of bacteria helps to under- stand the changes in bacterial resistance in hospitals, and provide the basis for empirical antimicrobial use.