【摘要】 目的了解2013年上海市细菌耐药性监测结果。方法采用纸片扩散法或自动化仪器法对上海市40所医院的临床分离菌进行药敏试验。其中包括28所三级医院和12所二级医院,采用CLSI 2013年版标准判断结果。结果总计98 185株临床分离菌,革兰阳性菌26 655株,占27.1%,革兰阴性菌71 530株,占72.9%。耐甲氧西林金黄色葡萄球菌(金葡菌)(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为50.8%和77.6%。在二级医院和三级医院MRSA、MRCNS的平均检出率分别为55.1%、80.6%和49.8%、77.0%。葡萄球菌属中未发现万古霉素、替考拉宁和利奈唑胺耐药株。726株儿童肺炎链球菌非脑膜炎分离株中青霉素敏感、中介和耐药(PSSP、PISP和PRSP)的检出率分别为56.7%、15.6%和27.7%,107株成人分离株为91.6%、2.8%和5.6%。发现35株屎肠球菌和17株粪肠球菌对万古霉素耐药(VRE)。根据表型推测,多数VRE为VanA基因型。大肠埃希菌、克雷伯菌属和奇异变形杆菌中产ESBLs菌株的检出率分别为61.3%、37.1%和39.5%。上述3种细菌中产ESBLs菌株的检出率在二级医院和三级医院的检出率分别为63.0%、31.6%、56.3%和60.7%、38.7%、33.5%。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,对亚胺培南和美罗培南的总耐药率分别为5.8%和6.6%。铜绿假单胞菌和不动杆菌属对亚胺培南、美罗培南耐药率分别为25.3%、24.3%和52.6%、56.0%。大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中有少数菌株为对所有测试药物耐药的广泛耐药株。分离自尿液标本中的肠球菌属和大肠埃希菌对磷霉素的耐药率低。结论细菌耐药性仍对临床抗感染治疗构成严重威胁,尤其是二级医院中某些细菌的耐药率高于三级医院,应引起高度关注。更多还原

【Abstract】 Objective To investigate the resistance of clinical bacterial isolates to antibiotics in Shanghai hospitals from January through December in2013.Methods Antimicobial susceptibility testing was carried out for the clinical isolates from40 hospitals(including 28 tertiary hospitals and 12 secondary hospitals)according to a unified protocol using Kirby-Bauer(KB)method or automated systems.Results were analyzed according to CLSI 2013 breakpoints.Results Of the 98 185 clinical isolates,gram positive cocci and gram negative bacilli accounted for 27.1%(26 655/98 185)and 72.9%(71 530/98 185),respectively.The overall prevalence of MRSA in Staphylococcus aureus was 50.8% and 77.6% for MRCNS in coagulase-negative Staphylococcus.The average prevalence of MRSA and MRCNS was 55.1% and 80.6% in secondary hospitals,49.8% and77.0%in tertiary hospitals.No strains were found resistant to vancomycin,teicoplanin or linezolid.About 56.7% of the 726 strains of non-meningitis S.pneumoniae isolated from children were penicillin-susceptible(PSSP),43.3% were penicillinnonsusceptible,including penicillin-intermediate(PISP,15.6%)and penicillin-resistant(PRSP,27.7%)strains.Of the 107 strains isolated from adults,91.6%,2.8% and 5.6% were PSSP,PISP and PRSP,respectively.Overall,35 strains of vacomycin-resistant E.feacium and 17 strains of vacomycin-resistant E.feacalis were identified.Most of these resistant strains were VanA type based on their phenotype.The overall prevalence of ESBLs-producing srains was 61.3%in E.coli,37.1%in Klebsiellaspp.and 39.5% in P.mirabilis.Specifically,the prevalence of such strains was 63.0%,31.6% and56.3%in secondary hospitals,60.7%,38.7% and 33.5%in tertiary hospitals,respectively.Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics.Overall,5.8% and 6.6% of the Enterobacteriaceae strains were resistant toimipenem and meropenem,respectively.Of the P.aeruginosa strains,25.3% and 24.3% were resistant to imipenem and meropenem,respectively.Of the Acinetobacter spp.strains,52.6% and 56.0% were resistant to imipenem and meropenem,respectively.A few extensively-drug resistant strains were identified in E.coli,K.pneumoniae,A.baumannii and P.aeruginosa.The strains of Enterococcusspp.and E.coli isolated from urine showed relatively lower resistance to fosfomycin.Conclusions It seems that antibicotic resistance is increasing in the clinical isolates,which poses a serious threat to the clinical practice.Special attention should be paid to the fact that the prevalence of resistant strains of some species in secondary hospitals is even higher than that in tertiary hospitals.更多还原