【摘要】 目的了解北京协和医院2009年临床分离株对常用抗菌药物的耐药性。方法纸片扩散法测定临床分离菌珠对常用抗菌药物敏感性,按CLSI2009年版判读结果,用WHONET5.4软件进行耐药性分析。结果 2009年共收集非重复临床分离株3 878株,其中革兰阴性菌占66.3%,革兰阳性菌占33.7%。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为40.3%和69.0%。MRSA中仍有约67.9%和81.6%的菌株分别对磺胺甲口恶唑-甲氧苄啶和磷霉素敏感,未发现万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。屎肠球菌和粪肠球菌均出现少数菌株对万古霉素和替考拉宁耐药,根据表型推测可能为VanA型耐药;未出现利奈唑胺耐药株。肺炎链球菌中青霉素耐药株(PRSP)占2.7%。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌、产酸克雷伯菌)、奇异变形杆菌中ESBLs阳性率分别为54.8%、29.3%和20.6%。未发现对亚胺培南和美罗培南耐药的菌株,但出现个别对厄他培南不敏感的菌株。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为23.9%和16.1%。鲍曼不动杆菌仅对米诺环素、头孢哌酮-舒巴坦的耐药率为30.4%和48.2%,其他抗菌药物耐药率均在70%以上。碳青霉烯类抗生素耐药铜绿假单胞菌(CRPA)和鲍曼不动杆菌(CRAB)检出率分别为24.7%、71.7%。结论临床分离细菌对常用抗菌药物耐药性呈增长趋势,VRE、CRAB、CRPA检出率增加显著,应加强抗生素的合理使用和医院感染控制。更多还原

【Abstract】 Objective To investigate the antimicrobial resistance of clinical isolates in Peking Union Medical College Hospital during 2009.MethodsThe susceptibility was tested by disk diffusion method.All the data were analyzed by WHONET 5.4 software according to CLSI 2009.ResultsA total of 3 878 clinical isolates were collected during 2009,of which gram negative organisms and gram positive cocci accounted for 66.3% and 33.7%,respectively.Methicillin resistant Staphylococcus aureus(MRSA) and coagulase-negative Staphylococcus(MRCNS) accounted for 40.3% and 69.0% respectively.About 67.9% and 81.6% of MRSA strains were still susceptible to sulfamethoxazole-trimethoprim and fosfomycin.No vancomycin,teicoplanin or linezolid resistant strains were found.For E.faecium and E.faecalis,some strains were resistant to vancomycin and teicoplanin.They were VanA phenotype.No linezolid resistant strains were found.About 2.7% of the S.pneumoniae strains were resistant to penicillin G(PRSP).The prevalence of ESBLs-producing E.coli,Klebsiella spp.and Proteus mirabilis were 54.8%,29.3% and 20.6%.No imipenem or meropenem resistant Enterobacteriaceae strains were found.However,there were some ertapenem-nonsusceptible strains.The percentage of P.aeruginosa strains resistant to imipenem and meropenem were 23.9% and 16.1%,respectively.More than 70% of A.baumannii strains were resistant to all the antibiotics tested except minocycline and cefoperazone-sulbactam,to which 30.4% and 48.2% were resistant respectively.The prevalence of carbapenem-resistant P.aeruginosa(CRPA) and carbapenem-resistant A.baumannii(CRAB) were 24.7% and 71.7%,respectively.ConclusionsBacterial resistance is still increasing,especially VRE,CRAB and CRPA.It is mandatory to take effective antibiotic policy and infection control measures.更多还原