【摘要】 目的了解2014年上海市细菌耐药性监测情况。方法采用纸片扩散法(K-B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。包括28所三级医院和12所二级医院,其中含3所儿童医院。采用CLSI 2014年版标准判断结果。结果总计102 113株临床分离菌,革兰阳性菌27 482株,占26.9%;革兰阴性菌74 631株,占73.1%。MRSA和MRCNS的检出率分别为47.4%和79.8%。MRSA、MRCNS在二级医院和三级医院的平均检出率分别为51.1%、79.9%和46.6%、79.8%。葡萄球菌属中未发现万古霉素和替考拉宁耐药株。845株儿童非脑膜炎分离株中青霉素敏感(PSSP)、中介(PISP)和耐药(PRSP)株的检出率分别为70.1%、14.6%和15.4%;167株成人分离株的PSSP、PISP和PRSP分别为97.6%、1.2%和1.2%。发现67株屎肠球菌和14株粪肠球菌耐万古霉素。根据PCR测序,多数万古霉素耐药肠球菌为van A和van M基因型。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中ESBL的检出率分别为59.4%、35.9%和30.1%。上述ESBL菌株在二级医院和三级医院的检出率分别为61.6%、31.6%、35.0%和58.9%、36.9%、29.5%。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均为7.0%。鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌中有少数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构成严重威胁,临床需合理规范应用抗菌药物,避免耐药株的广泛传播。更多还原

【Abstract】 Objective To investigate the resistance of clinical bacterial isolates to antibiotics in Shanghai hospitals during 2014. Methods Antimicobial susceptibility testing was carried out for the clinical isolates collected from 40 hospitals( including 28 tertiary hospitals and 12 secondary hospitals) according to a unified protocol using Kirby-Bauer( K-B) method or automated systems. Results were analyzed according to CLSI 2014 breakpoints. Results Of the 102 113 clinical isolates, gram positive cocci and gram negative bacilli accounted for 26.9% and 73.1%, respectively. The overall prevalence of MRSA in Staphylococcus aureus was 47.4% and 79.8% for MRCNS in coagulase-negative Staphylococcus. The average prevalence of MRSA and MRCNS was 51.1% and 79.9% in secondary hospitals, 46.6% and 79.8% in tertiary hospitals. No strains were found resistant to vancomycin or teicoplanin. About 70.1% of the 845 strains of non-meningitis S. pneumoniae isolated from children were penicillin-susceptible(PSSP), 30.0% were penicillin-nonsusceptible, including penicillin-intermediate(PISP, 14.6%) and penicillin-resistant(PRSP, 15.4%) strains. Of the 167 strains isolated from adults, 97.6%, 1.2% and 1.2% were PSSP, PISP and PRSP, respectively. Overall, 67 strains of vacomycin-resistant E. feacium and 14 strains of vacomycin-resistant E. feacalis were identified. According to PCR results, most of these resistant strains were van A and van M type based on their phenotype. The overall prevalence of ESBLs-producing strains was 59.4% in E. coli, 35.9% in Klebsiella spp.(K. pneumoniae and K. oxytoca) and 30.1% in P. mirabilis. Specifically, the prevalence of such strains was 61.6%, 31.6% and 35.0% in secondary hospitals, 58.9%, 36.9% and 29.5% in tertiary hospitals, respectively. Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics. Overall, both 7.0% of the Enterobacteriaceae strains were resistant to imipenem and meropenem, respectively. A few extensively drug- resistant strains were identified in A. baumannii, K. pneumoniae, P. aeruginosa, and E. coli. The strains of Enterococcus spp. 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. Rational use of antibiotics should be required to prevent the spread of drug resistant strains.更多还原