【摘要】 目的调查我国10所教学医院革兰阳性球菌临床分离株的耐药性。方法收集2007年下半年全国10所教学医院分离的非重复革兰阳性球菌931株,以琼脂稀释法测定抗菌药物的MIC。采用CLSI2008年版判断药敏结果。结果152株肺炎链球菌(全部为非脑脊液标本,采用静脉青霉素折点判断),青霉素耐药株(PRSP)和青霉素中介株(PISP)分别占2.6%和25.0%。所有肺炎链球菌均对万古霉素和替考拉宁高度敏感;对左氧氟沙星和莫西沙星的敏感率分别为98.0%和100%;对阿莫西林-克拉维酸、头孢曲松和氯霉素的敏感率分别为72.4%、80.9%和84.2%;青霉素敏感的肺炎链球菌(PSSP)对头孢丙烯和头孢克洛的敏感率分别为64.5%和59.1%,但PISP和PRSP对这2种抗生素均耐药。金葡菌和凝固酶阴性葡萄球菌(CSN)中耐苯唑西林菌株分别占49.5%和84.8%。无替考拉宁和万古霉素耐药的金葡菌;共发现替考拉宁中介的苯唑西林耐药溶血葡萄球菌(MRSH)3株和苯唑西林耐药表皮葡萄球菌(MRSE)1株。MRSA对氯霉素、复方磺甲口恶唑和利福平的敏感率分别为83.2%、71.1%和50.0%。粪肠球菌和屎肠球菌对高浓度庆大霉素耐药率分别为60.4%和75.9%。未发现对万古霉素和替考拉宁耐药的粪肠球菌;2株屎肠球菌对万古霉素耐药。除氯霉素和四环素外,粪肠球菌对其他所测抗菌药物的敏感率均高于屎肠球菌。结论各地区革兰阳性球菌对抗菌药物的耐药性有所差异,PISP有逐年上升趋势。替考拉宁和万古霉素对革兰阳性球菌具有很好的抗菌活性。更多还原

【Abstract】 Objective To investigate the antimicrobial resistance among gram-positive cocci isolated from patients in China during 2007.MethodsFrom June to December 2007,931 consecutive and non-duplicate gram-positive bacterial isolates were collected from 10 teaching hospitals.The minimal inhibitory concentrations(MICs) of antibacterial agents were determined by agar dilution method.MIC results were interpreted according to CLSI(2008) standards.ResultsAccording to the breakpoint of parenteral penicillin,the prevalence of penicillin-resistant(PRSP) and penicillin-intermediate S.pneumoniae(PISP) was 2.6% and 25% respectively among the 152 S.pneumoniae isolates.Vancomycin and teicoplanin were the most active agents against S.pneumoniae.Furthermore,98% and 100% of the S.pneumoniae isolates were susceptible to levofloxacin and moxifloxacin.Amoxicillin-clavulanic acid,ceftriaxone and chloramphenicol could inhibit 72.4%,80.9% and 84.2% of these isolates respectively.About 64.5% and 59.1% of the penicillin-susceptible S.pneumoniae(PSSP) were also susceptible to cefprozil and cefaclor respectively.All the PISP and PRSP isolates were resistant to cefprozil and cefaclor.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA) and methicillin-resistant coagulase-negative Staphylococcus(MRCNS) was 49.5% and 84.8%,respectively.All isolates of S.aureus were susceptible to vancomycin and teicoplanin.There were 3 MRSH(methicillin-resistant S.haemolyticus) and 1 MRSE(methicillin-resistant S.epidermidis) were intermediate to teicoplanin.About 83.2%,71.1% and 50% of the MRSA isolates were susceptible to chloramphenicol,trimethoprim-sulfamethoxazole and rifampin,respectively.About 60.4% of E.faecalis and 75.9% of E.faecium isolates were resistant to high level gentamicin.The susceptibility of E.faecalis to all the antibiotics except chloramphenicol and tetracycline were higher than E.faecium.All the E.faecalis isolates were susceptible to vancomycin and teicoplanin.Two vancomycin-resistant E.faecium isolates were identified.ConclusionsAntimicrobial resistance patterns of gram-positive cocci were different at various geographical regions.Teicoplanin and vancomycin are still highly active against gram-positive cocci.The prevalence of PISP seems to be increasing.更多还原