2010年度卫生部全国细菌耐药监测网报告:老年患者细菌耐药监测

目的 了解老年患者细菌感染种类分布及耐药特点.方法 用常规方法分离病原菌,用API鉴定或自动化细菌鉴定仪鉴定细菌,采用K-B纸片扩散法或自动化微量肉汤稀释法进行药敏试验；应用WHONET5.4软件进行统计分析.结果 全国125所医院＞65岁的老年患者共分离97 494株细菌,其中革兰阴性菌72 655株,革兰阳性菌24 839株,分离数前10位的依次为大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、嗜麦芽寡养单胞菌、屎肠球菌、阴沟肠杆菌、粪肠球菌；38.1％的细菌来源于痰标本,大肠埃希菌、肺炎克雷伯菌、产酸克雷伯和奇异变形菌产ESBLs的检出率分别为70.1％、54.1％、40.6％和32.7％；肠杆菌科对美罗培南的耐药率均＜5.0％,而肺炎克雷伯菌对亚胺培南的耐药率已高达12.3％,铜绿假单胞菌和鲍氏不动杆菌对碳青霉烯类的耐药率分别为＜30.0％、55.0％,均对多黏菌素保持高度敏感性,敏感率分别为96.1％和96.0％ ;MRSA和MRCNS的分离率分别为69.9％和83.3％；未发现耐万古霉素、替考拉宁和利奈唑胺葡萄球菌属,肠球菌属对万古霉素和替考拉宁的耐药率均＜6.2％,未发现耐利奈唑胺肠球菌.结论 对＞65岁患者细菌耐药性应引起足够重视,加强抗菌药物合理使用以降低耐药性,并采取有效措施控制其传播.

Mohnarin annual report 2010:surveillance of bacterial resistance in elderly patients

OBJECTIVE To investigate the bacterial distribution and antibiotic resistance in clinical isolates from elderly patients.METHODS The pathogens were isolated by routine method and were identified by the API or automatic bacteria analysis system.K-B disc diffusion method or microbroth dilution method was adopted to detect the antimicrobial susceptibility.The data were statistically analyzed by WHONET 5.4 software.RESULTS A total of 97 494 clinical isolates were collected from elderly patients aged >65 in 125 hospitals across the country,among which 72 655 isolates were gram-negative bacilli and 24 839 isolates were gram-positive cocci.The top 10 isolated pathogens were as the following:Escherichia coli(E.coli),Pseudomonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae(K.pneumoniae),Staphylococcus aureus,coagulase-negative Staphylococcus,Stenotrophomonas maltophi,Enterococcus faecium,Enterbacter cloacae,and E.faecalis;50.0% of the isolates were isolated from sputum.The production rates of extended-spectrum β-lactamases(ESBLs) produced by E.coli,K.pneumoniae,K.oxytoca and Proteus mirabilis were 70.1%,54.1%,40.6% and 32.7%,respectively;the resistance rates to meropenem of Enterobacteriaceae were less than 5.0%,but resistance rate to imipenem of K.pneumoniae was up to 12.3%,and the resistance rates to carbopenems of P.aeruginosa and A.baumannii were less than 30.0% and 55.0%,respectively.The susceptibility rates to polymyxin of P.aeruginosa and A.baumannii were 96.1% and 96.4%,respectively.The isolation rates of MRSA and MRCNS were 69.9% and 83.3%,respectively.No vancomycin,teicoplanin or linezolid-resistant Staphylococcu isolates were found.Resistance rates of Enterococcus spp.to vancomycin and teicoplanin were less than 6.2%.No linezolid-resistantEnterococcus spp isolates were found. CONCLUSION Special attention should be paid to the antimicrobial resistance in elderly patients aged >65 years.It is important to rationally use antimicrobial agents and to take effective measures for the control of the spread of resistant isolates.