摘要
目的了解北京协和医院2013年临床分离细菌对抗菌药物的耐药性。方法收集2013年1月1日至12月31日北京协和医院临床分离的7236株非重复细菌,采用纸片扩散法或自动化仪器法进行药敏试验,按美国临床实验室标准化协会2013年版标准判读药敏结果,采用WHONET 5.6软件进行数据分析。结果 7236株非重复的细菌中,革兰阴性菌占71.1%（5147株）,革兰阳性菌占28.9%（2089株）。耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphalococcus aureus,MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（methicillin-resistant coagulase-negative Staphylococcus,MRCNS）的检出率分别为34.9%（244/700）和67.2%（123/183）。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。发现少数万古霉素和替考拉宁耐药的屎肠球菌,未发现对利奈唑胺耐药的肠球菌。产超广谱β-内酰胺酶（extended spectrumβ-lactamases,ESBLs）的大肠埃希菌、克雷伯菌属细菌（肺炎克雷伯菌和产酸克雷伯菌）和奇异变形杆菌的检出率分别为49.5%（698/1410）、25.4%（235/925）和22.6%（30/133）。肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感,总耐药率1.5%-2.3%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为19.4%和15.6%。鲍曼不动杆菌对上述两种抗菌药物的耐药率分别为70.9%和72.0%。泛耐药鲍曼不动杆菌的检出率为42.9%（306/714）。结论细菌耐药性仍是临床重要问题,特别是泛耐药鲍曼不动杆菌,应采取有效的医院感染控制措施和合理使用抗菌药物。
Objective To investigate the antimicrobial resistance of bacteria isolated from clinical samples in Peking Union Medical College Hospital in 2013. Methods A total of 7236 nonduplicate clinical isolates were collected from January 1 to December 31 , 2013. Disk diffusion test （Kirby-Bauer method） and automated systems were employed to test the antimicrobial resistance of these isolates. The data were analyzed using WHONET 5.6 software and judged according to the Clinical and Laboratory Standards Institute guideline 2013. Results Of the 7236 nonduplicate clinical isolates, Gram-negative and Gram-positive bacteria accounted for 71.1% （5147） and 28.9% （2089） , respectively. Methicillin-resistant Staphalococcus aureus （MRSA） accounted for 34. 9% （244/700） and methicillin-resistant coagulase-negative Staphylococcus （MRCNS） accounted for 67.2% （123/ 183 ） of Staphalococcus aureus isolates. No staphylococcus strains resistant to vancomycin, teicoplanin, or linezol id were detected. A few strains of Enterococcus faecium were found resistant to vancomycin and teicoplanin. No linezolid-resistant enterococcus strains were found. Extended spectrum 13-1actamases （ESBLs）-producing strains accounted for 49.5% （698/1410）, 25.4% （235/925） and 22. 6% （30/133） in Escherichia coli, Klebsiella species （K. pneumoniae and K. oxytoca） and Proteus mirabilis, respectively. The Enterobacteriaeeae strains were still highly sensitive to carbapenems, with only 1.5% -2. 3% resistant to carbapenems. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 19.4% and 15.6% , respeetively. The resistance rates of Acinetobaeter baumannii to these two antimicrobials were 70.9% and 72.0% , respectively. The prevalence of pan-resistant strains in Acinetobacter baumannii was 42.9% （306/714）. Conclusions Antimierobial resistanee is still a serious problem, espeeially pan-resistant Aeinetobaeter baumannii strains. It is mandatory to take effective measures controlling nosocomial infection and ensuring rational antimicrobial use.
出处
《协和医学杂志》
2014年第4期422-428,共7页
Medical Journal of Peking Union Medical College Hospital
关键词
细菌耐药性监测
抗菌药
泛耐药菌
药敏试验
antimicrobial resistance surveillance
antimicrobial agents
pan-resistant bacteria
antimicrobial susceptibility test
