【摘要】 目的监测我国主要城市三级甲等医院住院患者分离革兰氏阳性菌耐药状况,掌握耐药流行趋势,为抗菌药物合理使用提供科学数据。方法定点收集来自全国18家医院临床分离细菌,由中心实验室统一用平皿/肉汤二倍稀释法测定抗菌药物最低抑菌浓度(MIC),参照美国临床和实验室标准协会(CLSI)或欧洲药敏委员会(EUCAST)2017标准判定细菌敏感、耐药率。结果对来自全国18座城市18家医院的2301株临床分离革兰氏阳性致病菌进行了MIC测定。结果显示,甲氧西林耐药金黄色葡萄球菌(MRSA)和甲氧西林耐药表皮葡萄球菌(MRSE)检出率分别为39.9%和86.8%。未发现万古霉素不敏感葡萄球菌。金黄色葡萄球菌对利奈唑胺、替考拉宁100%敏感,凝固酶阴性葡萄球菌对万古霉素以外的其他测试药物均出现耐药或不敏感。粪肠球菌、屎肠球菌对氨苄西林的耐药率分别为4.5%和85.1%。万古霉素耐药肠球菌(VRE)检出率2.06%,利奈唑胺不敏感率粪肠球菌比例为7.8%,有增加趋势。青霉素不敏感肺炎链球菌(PNSSP)检出率按非脑膜炎、非肠道系统给药折点计算为6.6%,按口服青霉素V折点计算为70.0%,与前次监测持平。金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、屎肠球菌的不同病房、不同年龄以及不同标本来源菌株耐药率比较均无显著差异。结论 VRE检出率稳定在低水平;MRSA检出率有所下降;新抗菌药物如利奈唑胺、替加环素、达托霉素等陆续出现耐药或不敏感菌株,值得注意。更多还原

【Abstract】 Objective To investigate the gram-positive coccus resistance in nationwide’s tietiary hospitals and understand the trend of antimicrobial resistance. Methods All the clinical isolates were collected from18 hospitals and the minimal inhibitory concentrations( MICs) were tested using agar/broth dilution method recommended by Clinical and Laboratory Standards Institute( CLSI) in central laboratory. The susceptibilities of isolates to antimicrobial agents were determined by using CLSI or European Committee on Antimicrobial Susceptibility Testing( EUCAST)2017 guideline. Results A total of 2301 Gram-positive cocci isolated from 18 hospitals in 18 cities nationwide were studied. Based on the MIC results, the prevalence of methicillin resistant Stapylococcus aureus( MRSA) and methicillin resistant Stapylococcus epidermidis( MRSE)were 39. 9% and 86. 6% respectively. No vancomycin insensitiveStaphylococcus was detected. Staphylococcus aureus were 100% susceptibile to linezolid and teicoplanin,but resistant or insensitive for drugs other than vancomycin were observed among Coagulase Negative Staphylococci( Co NS). Antibiotic resistance rate of Enterococcus faecalis and Enterococcus faecium to ampicillin were 4. 5% and 85. 1%. The detectation rate of vancomycin resistant Enterococcus( VRE) was 2. 1%. Nonsusceptibility rate of Enterococcus faecalis to linezolid was 7. 8%,showing slight increase than last time. The prevalence of penicillin nonsusceptible Streptococcus pneumoniae( PNSSP) was 6. 6% based on non-meningitis and parenteral administration criterion; while for cases of oral penicillin,the rate was 70. 0%,was as flat as last time. There were no significant differenees of resistance rates of Stapylococcus aureus,Stapylococcus epidermidis Enterococcus faecalis and Enterococcus faecium among various groups such as different department,age,or specimen source. Conclusion Compared with past surveillance result,VRE detection ratio was steady,while MRSA detection ratio decreased. The emergence of resistance and non-susceptible strains to new antibiotics such as linezolid,tigecycline and daptomycin should be payed more attention.更多还原