Mohnarin2010年度报告:ICU细菌耐药性监测

目的 了解我国来源于重症监护病房(ICU)患者病原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,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日上报数据中明确标明ICU来源的菌株进行分析.结果 ICU共分离到病原菌14 712株(按患者首次分离株进行统计),其中革兰阴性菌10 864株占73.8％,革兰阳性菌3848株占26.2％,前5位分别为鲍氏不动杆菌3185株占21.6％、铜绿假单胞菌1802株占12.2％、肺炎克雷伯菌1543株占10.5％、金黄色葡萄球菌1519株占10.3％、大肠埃希菌1390株占9.4％；标本主要来源于痰、血和尿；耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌的检出率分别为79.4％、73.9％和91.6％,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0.8％和4.9％对万古霉素耐药,0.8％和2.3％对替考拉宁耐药,0.5％和0.9％对利奈唑胺耐药；大肠埃希菌对三代头孢菌素及喹诺酮类的耐药率较高,产ESBLs大肠埃希菌和肺炎克雷伯菌的比率分别为68.5％和79.0％；鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药率＞80.0％.结论 我国ICU来源细菌以非发酵菌、肺炎克雷伯菌、金黄色葡萄球菌及大肠埃希菌为主；细菌的耐药状况进一步恶化,必须采取有效措施加以控制.

Mohnarin report of 2010:monitoring of bacterial resistance in intensive care units

OBJECTIVE To determine the bacterial distribution and drug resistance from ICU in China. METHODS Disc diffusion test,MIC test and E-test were used to detect the antimicrobial susceptibility of bacterial isolates from ICU patients.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 1 4712 bacterial strains were isolated in the survey period,which included 10864(73.8%) gram-negative strains,3848(26.2%) Gram-positive strains.Acinetobacter baumannii(385 strains,21.6%),Pseudomonas aeruginosa(1802 strains,12.2%),Klebsiella pneumoniae(1543 strains,10.5%),Staphylococcus aureus(1519strains,10.3%) and Escherichia coli(1390 strains,9.4%) were the five most common isolates.The bacteria were isolated from sputum,blood and urine majorly.The cefoxitin-resistant S.aureus,S.epidermidis and S.haemolyticus were 79.4%,73.9% and 91.6%,respectively.No Staphylococcus strain was resistant to vancomycin and linezolid.The resistance rates of Enterococcus faecalis and E.faecium to vancomycin were 0.8% and 4.9%,to teicoplanin 0.8% and 2.3%,while to linezolid 0.5% and 0.9% respectively.The resistant rates of E.coli to the third generation cephalosporin and fluoroquinolones were more higher.ESBLs productive rates of E.coli and K.pneumoniae were 68.5% and 79.0%,and the carbapenem resistance rates of A.baumannii was over 80.0%. CONCLUSION Glucose non-fermenting bacteria,K.pneumoniae,S.aureus and E.coli still are the predominant pathogens in ICU infections in China.Bacterial resistance is getting further deterioration;more effective measures should be taken to control it.