中国西部地区革兰阳性菌的耐药及分布特点

目的 了解中国西部地区临床分离革兰阳性菌对常用抗菌药物的敏感性和耐药性。方法 对中国西部地区10所医 院临床分离的革兰阳性菌采用纸片扩散法或自动化仪器法进行抗菌药物敏感性试验。参照2017年CLSI文件标准判读结果。结果 共收集2016年、2017年上述医院临床分离革兰阳性菌16558株和19263株，阳性菌中分离前3位的依次为金黄色葡萄球菌、屎肠 球菌和肺炎链球菌。MRSA 2016年和2017年的分离率分别为34.9%和32.8%。MRSA对绝大多数测试药物的耐药率均显著高于 MSSA。未发现万古霉素、利奈唑胺和替考拉宁耐药菌株。肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠 球菌，两者中均有少数万古霉素耐药株。A组、B组除对红霉素和克林霉素有较高的耐药率外，B组链球菌对左氧氟沙星也有较 高的耐药率，对其它测试抗菌药物有较好的敏感性。肺炎链球菌非脑膜炎株红霉素、克林霉素和复方磺胺甲噁唑耐药率较高。 未发现万古霉素和利奈唑胺耐药株。结论 MRSA检出率有下降的趋势；耐万古霉素肠球菌分离率处于较低水平；万古霉素、 利奈唑胺、替考拉宁对革兰阳性球菌有很好的抗菌活性。不同地区革兰阳性菌耐药性有所差异，应重视耐药性监测并加强抗菌 药物合理应用。

Drug resistance and distribution characteristics of Gram-positive bacteria in Western China

Abstract Objective To understand the sensitivity and drug resistance of clinically isolated Gram-positive bacteria against commonly used antibacterial drugs agents in Western China. Methods Gram-positive bacteria isolated from 10 hospitals in Western China were tested for antimicrobial susceptibility by Kirby-Bauer test or automated instrumentation. Breakpoint standard of CLSI 2017 M100-s27th was recommended to determinate results. Result A total of 16,558 strains and 19,263 strains of clinically isolated Gram-positive bacteria were collected from the above hospitals in 2016 and 2017. The top 3 isolates of positive bacteria were Staphylococcus aureus, Enterococcus faecium and Streptococcus pneumoniae. The isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) in 2016 and 2017 were 34.9% and 32.8%, respectively. The resistance rate of MRSA to most tested drugs was significantly higher than that of methicillin sensitive Staphylococcus aureus(MSSA). Vancomycin, linezolid and teicoplanin resistant strains were not found. The resistance rate of Enterococcus faecalis to most tested antibacterial was significantly lower than that of Enterococcus faecium, and there were a few vancomycin resistant strains was found in both. Group A and group B had higher resistance rates to erythromycin and clindamycin, group B Streptococcus also had higher resistance rate to levofloxacin, and had better sensitivity to other tested antibacterial drugs. There was high resistance rate of erythromycin, clindamycin and cotrimoxazole in Streptococcus pneumoniae non-meningitis strain. There were no vancomycin and linezolid resistant strains were found. Conclusion MRSA detection rate has a downward trend; vancomycin-resistant enterococci isolation rate is at a low level; vancomycin, linezolid, and teicoplanin have good antibacterial activity against Gram-positive cocci. There are differences in drug resistance of Gram-positive bacteria in different regions, and paid attention on drug resistance monitoring and rational application of antimicrobial