Mohnarin2010年度报告:非ICU住院患者细菌耐药性监测

目的 了解2010年全国非ICU住院患者中临床分离细菌的分布及对抗菌药物的耐药性.方法 采用纸片法、MIC法或E-test法测定细菌对抗菌药物的敏感性,依据CLSI 2010年标准,使用WHONET5.4软件对卫生部全国细菌耐药性监测网(Mohnarin)所属59所三级甲等医院2010年1月1日-12月31日上报数据中非ICU住院患者分离的菌株进行分析.结果 非ICU住院患者中共分离到细菌47 203株(按患者首次分离株进行统计),其中革兰阴性菌株33 110株占70.1％,革兰阳性菌14 093株占29.9％,前5位细菌为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌,分别占17.8％、11.3％、10.7％、9.4％、8.5％；金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐头孢西丁菌株分别占48.9％和64.2％,未发现对万古霉素耐药株,对替考拉宁出现少量耐药株；粪肠球菌和屎肠球菌分别有0.6％和2.3％对万古霉素耐药,0.4％和1.2％对替考拉宁耐药；大肠埃希菌、肺炎克雷伯菌中产ESBLs菌株检出率分别为68.6％和41.9％,各种肠杆菌科细菌对阿米卡星及含酶抑制剂类抗菌药物的耐药率＜25.0％,对碳青霉烯类抗菌药物仍保持较高的敏感性；铜绿假单胞菌及鲍氏不动杆菌的耐药明显,对碳青霉烯类耐药率高于往年监测数据；嗜麦芽寡养单胞菌对喹诺酮类、米诺环素的耐药率＜25.0％.结论 我国住院非ICU患者细菌以肠杆菌科、非发酵菌、葡萄球菌属为主,MRSA、产ESBL肠杆菌科细菌、耐碳青霉烯非发酵菌以及对喹诺酮耐药肠杆菌科十分突出,且呈增长趋势.

Mohnarin report of 2010:surveillance of bacterial resistance of non-ICU inpatients

OBJECTIVE To investigate the bacterial distribution and antibacterial resistance of clinical isolates from non-ICU inpatients in China. METHODS Disc diffusion test,MIC test and E-test were used to detect the antimicrobial susceptibility of bacterial isolates from non-ICU inpatients in China.WHONET 5.4 was applied for analyzing the bacterial susceptible data from 59 tertiary Mohnarin member hospitals in China from January 1,2010 to December 31,2010. RESULTS A total of 47 203 bacterial strains were isolated in the survey period,which included 33 110(70.1%) gram-negative strains,14093(29.9%) gram-positive strains.Escherichia coli(17.8%),Klebsiella pneumoniae(11.3%),Pseudomonas aeruginosa(10.7%),Acinetobacter baumannii(9.4%),Staphlococcus aureus(8.5%) were the most common isolates.Cefoxitin-resistant S.aureus(MRSA) and coagulase-negative Staphylococci(MRCNS) accounted for 48.9% and 64.2%,respectively.There was no glycopeptides-resistant Staphylococcus to be found,but a few of coagulase-negative Staphylococci were teicoplanin-resistant.Vancomycin-resistant Enterococcus faecalis and E.faecium was 0.6% and 2.3%,and teicoplanin-resistant 0.4% and 1.2%,respectively.The detected rates of ESBLs-producing E.coli and K.pneumoniae were 68.6% and 41.9%,respectively,The drug resistant rates of Enterobacteriaceae to amikacin and beta-lactamase inhibitors combinations were below 25.0%.Carbapenem were still highly potent against Enterobacteriaceae.The drug resistant rates of P.aeruginosa and A.baumannii were higher than those of previous surveillance,especially to carbapenems.The resistant rates of Stenotrophomonas maltophilia to quinolones and minocycline were below 25.0%. CONCLUSION Enterobacteriaceae,non-fermenting bacteria and Staphylococci are the predominant pathogens in non-ICU inpatients.Bacterial drug resistance is getting worse.Especially MRSA,ESBL positive Enterobacteriaceae,carbapenem-resistant non-fermenters and fluoroquiolone-resistant E.coli are predominant threat for antimicrobial therapy.