湘雅医院细菌耐药性监测

目的了解中南大学湘雅医院2009年临床常见分离菌的分布及耐药性。方法采用Vitek 2全自动微生物鉴定分析系统对临床分离菌株进行鉴定及药敏试验,WHONET 5.4统计软件对数据进行分析。结果 7 841株临床分离菌株中,革兰阳性菌占28.5%（2 237/7 841）,革兰阴性菌占55.7%（4 369/7 841）,真菌占15.8%（1 235/7 841）。革兰阳性球菌居前五位的分别为凝固酶阴性葡萄球菌、金黄色葡萄球菌、粪肠球菌、屎肠球菌和血液链球菌。耐甲氧西林金黄色葡萄球菌（MRSA）和凝固酶阴性葡萄球菌（MRCNS）的检出率分别为63.7%和67.2%,未发现万古霉素耐药或中介的葡萄球菌,但分离到万古霉素耐药肠球菌（VRE）7株。革兰阴性杆菌中分离率居前五位的依次为铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌和阴沟肠杆菌。肠杆菌科细菌中,大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌对碳青霉烯类抗生素的耐药率最低（〈2.3%）,大肠埃希菌、肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率〈13.0%,而阴沟肠杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率分别达40.0%和28.4%。非发酵菌中,铜绿假单胞菌对美洛培南、头孢哌酮/舒巴坦的耐药率较低,分别为9.1%和12.4%;鲍曼不动杆菌对头孢哌酮/舒巴坦、左氟沙星及氨苄西林/舒巴坦耐药率较低,分别为7.0%、7.6%和16.3%,对美洛培南耐药率达28.8%;对其他抗菌药物耐药率均超过40%。结论该院常见病原菌以革兰阴性杆菌为主;病原菌对多种临床常用抗菌药物耐药,尤其是对万古霉素耐药肠球菌的出现及对碳青霉烯类耐药非发酵菌的增加,应引起临床高度重视,及时采取有效措施,控制耐药菌在医院内播散和暴发流行。

Surveillance of Bacterial Resistance in Clinical Isolates from Xiangya Hospital

Objective To investigate the distribution and antibiotic resistance of clinical isolates collected from Xiangya Hospital of Central South University in 2009. Methods The isolates and their susceptibilities were determined by automatic microorganism analytical system VITEK-2.All the data were analyzed by WHONET 5.4 software. Results A total of 7,841 isolates were collected,of which gram positive cocci,gram negative organisms and fungus accounted for 28.5%(2,237/7,841),55.7% (4,369/7,841),and 15.8%(1,235/7,841),respectively.The first 5 gram positive cocci were coagulase negative Staphylococcus(CNS),Staphylococcus aureus,Enterococcus faecalis,Enterococcus faecium and Streptococcus sanguis.Methicillin resistant strains in S.aureus(MRSA) and coagulase negative Staphylococcus(MRCNS) accounted for 63.7% and 67.2%,respectively.No staphylococcal strain was intermediate or resistant to vancomycin.Seven strains of Enterococcus spp.were resistant to vancomycin(VRE).The first 5 gram negative bacilli were Pseudomonas aeruginosa,Escherichia coli,Acinetobacter baumannii,Klebsiella pneumonia,and Enterobacter cloacae.The strains of Enterobacteriaceae,like E. coli,K.pneumonia,and E.cloacae,had very low resistance rates to carbopenems(<2.3%).The resistance rates of E.coli and K.pneumonia to piperacillin/tazobactam or cefoperazone/sulbactam were less than 13.0%.The resistance rates of E.cloacae to piperacillin/tazobactam and cefoperazone/sulbactam were 40.0% and 28.4%,respectively.Among non-fermenter,the resistance rates of P.aeruginosa to meropenem and cefoperazone/sulbactam were 9.1% and 12.4%,respectively.The resistance rates of A.baumannii to cefoperazone/sulbactam,levofloxacin and and ampicillin/ sulbactam were 7.0%,7.6% and 16.3%,respectively.The resistance rate of A.baumannii to meropenem was high(28.8%) and was even higher to other commonly used antibiotics(>40%). Conclusions Gram negative bacilli are still the major isolates and multidrug resistance is serious in our hospital.Clinical doctors should pay special attention to the increasing strains of vacomycin resistant Enterococcus spp. and carbapenems-resistant non-fermenter.It is urgent that effective control measures should be taken to prevent dissemination and outbreak of these stains.