【摘要】 目的调查广州医学院第一附属医院临床常见分离菌对抗生素耐药性四年间的变迁。方法药敏试验采用纸片扩散法,依照美国临床实验室标准化委员会制定的各年度版本标准判定结果,数据分析采用WHONET5.4软件,对四年间的资料作回顾性调查分析。结果2005-2008年共收集非重复分离菌7920株,革兰阴性菌为为5810株,革兰阳性菌2110株。MRSA的分离率从2005年的44.8%增加到2008年的67.7%,未出现对万古霉素、替考拉宁和利奈唑胺中介和耐药的葡萄球菌。肺炎链球菌对青霉素的不敏感率为28%。未出现对万古霉素耐药粪肠球菌和屎肠球菌。碳青酶烯类对肠杆菌科细菌耐药率低于5%,头孢吡肟4年来对肠杆菌科细菌敏感率在70%以上,头孢噻肟耐药率逐年维持在40%左右,含酶抑制剂的头孢哌酮/舒巴坦,哌拉西林/三唑巴坦的敏感性在80%以上,喹诺酮类环丙沙星、左氧氟沙星敏感率4年来低于50%;大肠埃希菌和肺炎克雷伯菌中ESBLs的总检出率分别为23.8%和32.1%,产ESBL株的耐药率明显高于非产ESBL株;2005-2007年产ESBL肺炎克雷伯菌对美罗培南敏感率为100%,2008年对美罗培南的耐药率为5.2%。4年来主要非发酵菌的分离率都有不同程度升高,总分离率排前三位的是铜绿假单胞菌(15%)、鲍曼不动杆菌(5.4%)、嗜麦芽寡养单胞菌(4.7%);铜绿假单胞菌对头孢噻肟、头孢他啶,头孢吡肟,庆大霉素、阿米卡星,环丙沙星、左氧氟沙星以及哌拉西林/三唑巴坦的耐药率4年来逐年呈下降趋势。结论肺炎克雷伯菌对碳青霉烯类耐药率上升,非发酵菌的分离率上升但耐药率下降,细菌总体耐药变化符合国内耐药监测变化的趋势但有本院的特点,监测结果对抗菌药物的选择和医院感染的控制有积极意义。更多还原

【Abstract】 Objective To investigate the distribution and prevalence of antimicrobial susceptibility in the First Affiliated Hospital of Guangzhou Medical College during 2005～2008.Methods Disc diffusion test was employed to study the antimicrobial resistance.WHONET 5.4 software was used for data analysis.Results A total of 7920 non-duplicate isolates were collected during 2005～2008.Gram-positive microorganisms accounted for 2110.Gram negative bacteria accounted for 5810.The prevalence of MRSA increased from 44.8% in 2005 to 67.7% in 2008.No vancomycin,teicoplanin and linezolid intermediate or resistant Staphylococcus aureus.Streptococcus pneumoniae none-sensitive to penicillin accounted for 28%.No vancomycin-resistant Enterococcus faecalis and Enterococcus feces were found.The rate of resistance to Green enzyme vinyl carbon in Enterobacteriaceae bacterial was less than 5%,the rate of sensitive to cefepime by Enterobacteriaceae was more than 70% during 4 years,resistance to cefotaxime in Enterobacteriaceae maintain at 40%,rate of sensitivity to cefoperazone/sulbactam,piperacillin/tazobactam was more than 80%,the sensity to ciprofloxacin,levofloxacin was below 50% during the 4 years.The rate of ESBLs produced by Escherichia coli and Klebsiella pneumoniae were 23.8% and 32.1%,ESBL producing strains were more resistant to the common antibiotics than ESBL non-producing strain.the rate of sensitive to meropenem by Klebsiella pneumonia during 2005～2007 was 100%,but it increased to 5.2% in 2008.during 4 years the most common non-fermentative bacterias isolated rate was Pseudomonas aeruginosa(15%),Acinetobacter baumannii(5.4%),Anopheles maltophilia single sobria(4.7%);the rate of sensitive to cefotaxime,ceftazidime,cefepime,gentamicin,amikacin,ciprofloxacin,levofloxacin by Pseudomonas aeruginosa declined by years during 2005～2008.Conclusion The rate of resistant to carbapenems by Klebsiella pneumoniae was increasing.the rate of separation by nonfermenters was increasing but the rate of resistance was declined.the trend of resistance pattern in line with the other districts in domestic but had its own characteristics.outcomes of the monitoring could provide useful information to the selection of antibiotics and hospital infection control.更多还原