2010年度卫生部全国细菌耐药监测网报告:ICU来源细菌耐药性监测

目的了解我国2010年来源于重症监护病房(ICU)患者病原菌的分布及耐药性。方法使用WHONET5.6软件进行分析,对卫生部全国细菌耐药监测网所属129所三级甲等医院2010年度ICU来源的菌株进行分析。结果 2010年度共收集ICU分离菌株27 034株,其中革兰阳性菌7078株占26.2%,革兰阴性菌19 956株占73.8%;革兰阳性菌中前3位分别为葡萄球菌属、肠球菌属、链球菌属,革兰阴性菌中占前5位的为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和嗜麦芽寡养单胞菌;采集标本占前3位的是痰液、血液和尿液,分别占63.2%、11.6%、5.0%;耐甲氧西林金黄色葡萄球菌检出率约80.0%,未发现耐万古霉素和利奈唑胺葡萄球菌;粪肠球菌和屎肠球菌中分别有1.4%和8.7%对万古霉素耐药,1.0%和5.9%对替考拉宁耐药;大肠埃希菌和肺炎克雷伯菌产ESBLs检出率分别为73.9%和54.5%;肠杆菌科细菌中存在一部分耐碳青霉烯类菌株,大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率为6.4%和14.5%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为40.4%和34.9%,鲍氏不动杆菌对两者的耐药率分别为72.9%和73.5%,但二者对多黏菌素B仍保持较高敏感性。结论我国ICU来源细菌仍然以非发酵菌、葡萄球菌属、肺炎克雷伯菌、大肠埃希菌为主,细菌的耐药性比较严重,必须加以注意,需要控制抗菌药物的使用并继续密切监测ICU病原菌耐药变化趋势。

Mohnarin annual report 2010:surveillance of antimicrobial resistance in bacteria isolated from intensive care units

OBJECTIVE To investigate the distribution and drug resistance of clinical isolates derived from ICU patients in China in 2010.METHODS The data of the isolates collected from ICU of 129 tertiary Mohnarin hospitals during 2010 were analyzed with WHONET 5.6.RESULTS A total of 27,034 isolates were collected in ICU during 2010,including 7078(26.2%) isolates of gram-positive bacteria and 19,956(73.8%) isolates of gram-negative bacteria.Staphylococcus spp.,Enterococcus spp.and Streptococcus spp.were the top three genus among gram-positive bacteria,whilst Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumonia,Escherichia coli(E.coli) and Stenotrophomonas maltophilia were the five most common isolates among gram-negative bacteria.The most common sampling sites were sputum,blood and urine,accounting for 63.2%,11.6% and 5.0% respectively.The detection rate of methicillin-resistant S.aureus was around 80.0%,but no vancomycin or linezolid-resistant Staphyloccus spp.were found.The resistance rates of E.faecalis and E.faecium,to vancomycin were 1.4% and 8.7%,and 1.0% and 5.9% to teicoplanin,respectively.73.9% of E.coli and 54.5% of K.pneumoniae isolates were ESBLs-producers.There were some carbapenems-resistant Enterobacteriaceae isolates.The resistance rates of E.coli and K.pneumonia to imipenem were 6.4% and-14.5%,respectively;the resistance rates of P.aeruginosa to imipenem and meropenem were 40.4% and 34.9%,and the resistance rates of A.baumannii,to imipenem and meropenem were 72.9% and 73.5%,respectively.But both P.aeruginosa and A.baumannii remained high susceptibility to polymyxin B. CONCLUSION Non-fermenting bacteria,Staphylococci,K.pneumonia and E.coli remain the predominant pathogens isolated from the patients in ICU.Bacterial resistance is serious.We should keep continuously close surveillance for the changes of bacterial resistance in ICU and control the use of antibiotics.