【摘要】 目的监测我国主要城市三级甲等医院血流分离病原菌耐药状况。方法定点收集来自全国18家医院血流分离致病菌,用美国临床和实验室标准协会(CLSI)推荐的平皿二倍稀释法,测定抗菌药物的最低抑菌浓度(MIC),用统计软件SPSS17.0处理MIC结果。结果共收集并测定1077株血标本来源细菌,其中革兰阳性菌38.6%(416/1077),革兰阴性菌61.4%(661/1077)。最常见细菌依次为大肠埃希菌(23.0%)、凝固酶阴性葡萄球菌(CoNS)(12.3%)、金黄色葡萄球(11.4%)、肺炎克雷伯菌(11.3%)、铜绿假单胞菌(7.2%)及鲍曼不动杆菌(6.5%)。各科室中内科细菌分离率最高为46.7%(503/1077),在重症监护病房(ICU)的分离菌的耐药率高于非ICU。按年龄分,成年人分离率最高,为58.8%(633/1077)。耐甲氧西林金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)检出率分别为54.5%(67/123)和80.5%(107/133)。未发现对利奈唑胺和万古霉素耐药的葡萄球菌属和肠球菌属致病菌。耐青霉素肺炎链球菌(PRPS)检出率为5.9%。超广谱β内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌率分别为72.6%(180/248)和40.2%(49/122)。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南不敏感率分别为71.8%(56/78)和68.6%(48/70),亚胺培南不敏感菌对抗菌药物的耐药率明显高于亚胺培南敏感菌株。多重耐药(MDR)率:金黄色葡萄球菌为65.0%(80/123),肠球菌属为50.9%(56/110),大肠埃希菌为81.0%(201/248),肺炎克雷伯菌为53.3%(65/122),铜绿假单胞菌为37.2%(29/78),鲍曼不动杆菌为74.3%(52/70)。本次监测发现1株屎肠球、10株大肠埃希菌、3株肺炎克雷伯菌、18株铜绿假单胞菌和50株鲍曼不动杆菌可能为泛耐药(XDR)菌;5株铜绿假单胞菌和1株鲍曼不动杆菌可能为全耐药(PDR)菌。结论血流感染分离菌呈多样性,以肠杆菌科和葡萄球菌为主,其中不乏MDR与XDR,甚至PDR菌。更多还原

【Abstract】 Objective To monitor the resistant situation of clinical isolates causing bloodstream infections in Third Level Hospital in our major cities,which can provide reference for instructing clinical doctors to use antimicrobials rationally. Methods Collect the organisms causing bloodstream infections from 18 hospitals in China and determine the minimum inhibitory concentration( MIC) of them using two- folder agar dilution test recommended by CLSI. The data were analyzed bysoftware SPSS17. 0. Results Atotal of 1077 strains from blood were collected and detected,of whom gram- positive and gram- negative organisms accountedfor 38. 6%( 416 /1077) and 61. 4%( 661 /1077),respectively.Escherichia coli( 23. 0%),Coagulase negative Staphylococcus( CoNS)( 12. 3%),Staphylococcus aureus( 11. 4%), Klebsiella pneumoniae( 11. 3%),Pseudomonas aeruginosa( 7. 2%) and Acinetobacter baumannii( 6. 5%) were the most common isolates. In all departments,medical department exhibited a highest prevalence at 46. 7%( 503 /1077),the antimicrobial resistant rates of intensive care unit( ICU) were higher than non- ICU. Adults displayed a peak rates at 58. 8%( 633 /1077) when all samples were splited by age. The incidences of meticillin- resistant S. aureus( MRSA) and coagulase negative Staphylococcus( MRSCN) were 54. 5%( 67 /123) and 80. 5%( 107 /133),respectively. No linezolid or vancomycin resistant Staphylococcus and Enterococcus were found. The rate of Penicillin- resistant Streptococcus pneumoniae( PRPS) was 5. 9%. The extended- spectrum β- lactamases( ESBLs) positive rates of E. coli and K. pneumoniae were72. 6%( 180 /248) and 40. 2%( 49 /122),respectively. P. aeruginosa and A. baumannii showed nonsensitive to imipenem at the rates of 71. 8%( 56 /78) and 68. 6%( 48 /70),respectively. The antimicrobial resistant rates of imipenem- NS isolates were much higher than imipenem- S ones. The multidrug- resistant( MDR) rates of S. aureus,Enterococcus,E. coli,K. pneumoniae,P. aeruginosa and A. baumannii were 65. 0%( 80 /123),50. 9%( 56/110),81. 0%( 201/248),53. 3%( 65/122),37. 2%( 29/78) and 74. 3%( 52/70),respectively. We found 1 strain of E. faecium,10 strains of E. coli,3 strains of K. pneumoniae,18 strains of P. aeruginosa and 50 strains of A. baumannii may be extensively drug- resistant( XDR); 5 strains of P. aeruginosa and 1 strain of A. baumannii may be pandrug- resistant( PDR). Conclusion The isolates causing bloodstream infections were various,most of which were Enterobacteraceae and Staphylococcus spp. There were also some MDR,XDR,and even PDR.更多还原