2010年中国CHINET临床分离自无菌体液的细菌分布和耐药性监测

目的了解国内不同地区14所教学医院2010年从临床分离自脑脊液及其他无菌体液(胸水、腹水、胆汁等)的细菌分布和对抗菌药物的耐药性。方法共收集2010年临床分离的无菌体液2409株非重复的细菌,采用纸片扩散法进行药敏试验,结果按CLSI 2010年版标准判读药敏结果,采用WHONET 5.4软件进行数据分析。结果 2409株非重复的细菌中,革兰阴性菌1 353株,占56.2%,革兰阳性菌1 056株,占43.8%。脑脊液中最常见的细菌分别为:凝固酶阴性葡萄球菌(CNS)、鲍曼不动杆菌、肺炎克雷伯菌、金葡菌和大肠埃希菌。其他无菌体液中最常见的细菌分别为:大肠埃希菌、CNS、屎肠球菌、肺炎克雷伯菌和铜绿假单胞菌。脑脊液标本中MRSA和MRCNS的检出率分别为78.6%和69.7%。其他无菌体液标本中MRSA和MRCNS的检出率分别为60.3%和67.2%。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。脑脊液标本中未发现对万古霉素耐药的肠球菌属细菌,在其他无菌体液中发现17株对万古霉素耐药的屎肠球菌。脑脊液标本中产ESBLs大肠埃希菌和克雷伯菌属细菌(肺炎克雷伯菌和产酸克雷伯菌)的检出率分别为62.5%和30.0%,其他无菌体液标本中产ESBLs大肠埃希菌和克雷伯菌属细菌(肺炎克雷伯菌和产酸克雷伯菌)的检出率分别为50.4%和27.3%。脑脊液标本中泛耐药鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌分别检出10株(18.2%)、8株(27.6%)和1株(7.7%)。其他无菌体液标本中泛耐药鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌分别检出43株(36.8%)、18株(11.5%)、3株(2.1%)和1株(0.2%)。结论脑脊液和其他无菌体液中主要病原菌是大肠埃希菌、CNS、屎肠球菌、肺炎克雷伯菌,鲍曼不动杆菌和铜绿假单胞菌。应防范泛耐药肠杆菌科细菌、铜绿假单胞菌和鲍曼不动杆菌对临床治疗造成严重威胁。

CHINET 2010 surveillance of bacterial distribution and resistance in sterile body fluids

Objective To investigate the distribution and antimicrobial resistance of the bacteria isolated from cerebrospinal fluid and other sterile body fluids from hospitals in several regions of China.Methods Twelve general hospitals and two children s hospitals were involved in this program.Disc diffusion test(Kirby-Bauer method),E-test and MIC determination were employed to study the antimicrobial resistance.The data were analyzed by WHONET 5.4 software according to CLSI 2010 breakpoints.Results A total of 2 409 nonduplicate clinical isolates were collected from January to December in 2010,of which gram negative organisms and gram positive cocci accounted for 56.2%(1 353/2 409) and 43.8%(1 056/2 409),respectively.Coagulase-negative Staphylococcus(CNS),B.baumannii, K.pneumoniae,S.aureus and E.coli were the most common bacterial species in cerebrospinal fluid.E.coli,CNS, E.faecium,K.pneumoniae and P.aeruginosa were the most frequently isolated species from other sterile body fluids.About 78.6%and 69.7%of the S.aureus and CNS isolates from cerebrospinal fluid were methicillin resistant,respectively,while 60.3%and 67.2%of the S.aureus and CNS strains from other sterile body fluids were methicillin resistant,respectively.No staphylococcal strain was found resistant to vancomycin,teicoplanin or linezolid.None of the enterococcal strains from cerebrospinal fluid was resistant to vancomycin.A total of 17 E.faecium strains from other sterile body fluid were found resistant to vancomycin.ESBLs-producing strains accounted for 62.5%and 30.0%in the E.coli and Klebsiella(K.pneumoniae,K. oxytoca) isolates from cerebrospinal fluid,respectively.About 50.4%and 27.3%of the E.coli and Klebsiella(K.pneumoniae, K.oxytoca) isolated from other sterile body fluid were ESBLs-producing strains.Pan-resistant strains were identified in the A.baumannii(n = 10,18.2%),K.pneumoniae(n=8,27.6%) and P.aeruginosa(n=l,7.7%) isolates from cerebrospinal fluid.Pan-resistant strains of A.baumannii(n = 43,36.8%),K.pneumoniae(n= 18,11.5%),P.aeruginosa(n= 3,2.1%) and E.coli(n= 1,0.2%) were isolated from other sterile body fluids.Conclusions The leading pathogenic bacteria isolated from cerebrospinal fluid and other sterile body fluid are E.coli,CNS,E.faecium,K.pneumoniae,A.baumannii and P.aeruginosa.More attention should be paid to the threats caused by the pan-resistant Enterobacteriaceae,P.aeruginosa and A.baumannii.