【摘要】 目的监测2007年和2009年我国不同地区13家教学医院内获得性血流感染中主要病原菌的分布并对其耐药性进行分析。方法收集医院内获得性血流感染的病原菌,并对其进行药物敏感性检测,采用WHONET5.6软件对数据进行分析。结果本研究共收集到2015株医院内获得性血流感染病原菌,其中革兰阴性杆菌1332株(占66.1%),革兰阳性球菌683株(占33.9%)。分离率排名前五位的病原菌分别为:大肠埃希菌(27.9%),肺炎克雷伯菌(11.3%),金黄色葡萄球菌(10.9%),铜绿假单胞菌(7.0%),鲍曼不动杆菌(6.0%)。对血流感染中常见革兰阴性杆菌体外药物敏感率较高的抗菌药物依次为:替加环素(98.2%,不包括铜绿假单胞菌),多黏菌素(98.1%,非发酵菌),头孢他啶/克拉维酸(90.4%);对常见革兰阳性球菌体外药物敏感率较高的抗菌药物有:替加环素和利奈唑胺(敏感率均为100%),万古霉素和替考拉宁(敏感率均为99.4%)。2007年度和2009年度数据显示:苯唑西林耐药金黄色葡萄球菌(MRSA)的发生率分别为42.3%和42.2%,产超广谱β-内酰胺酶肠杆菌科细菌(ESBLs)的发生率分别为54.7%和53.4%,多重耐药铜绿假单胞菌(MDRP)的发生率分别为11.9%和15.9%,多重耐药鲍曼不动杆菌(MDRA)的发生率分别为49.0%和64.8%,屎肠球菌和粪肠球菌对高水平庆大霉素耐药(HLGR)的发生率分别为62.6%和66.7%,对碳青霉烯类不敏感的发生率分别为2.1%和4.6%。高水平庆大霉素耐药(HLGR)肠球菌的发生率分别为62.6%和66.7%,碳青霉烯类不敏感肠杆菌的发生率分别为2.1%和4.6%。结论医院获得性血流感染病原菌主要为革兰阴性杆菌(以大肠埃希菌和肺炎克雷伯菌为主),替加环素和碳青霉烯类药物对其敏感率较高;革兰阳性球菌中分离率最高的为金黄色葡萄球菌、其次为屎肠球菌,替加环素、利奈唑胺、万古霉素和替考拉宁对其敏感率较高。多重耐药菌中MDRA、HLGR、MDRP以及碳青霉烯类不敏感肠杆菌科细菌的发生率分别升高了:15.8%、4.1%、4.0%和2.5%,应引起临床的关注。更多还原

【Abstract】 Objective To investigate the distribution and antimicrobial resistance of pathogenic bacteria of bloodstream infection from 13 clinical hospitals in China in 2007 and 2009.Methods Non-repetitive pathogens from nosocomial bloodstream infection were collected and tested for the drug-resistance.WHONET 5.6 software was used to analyze the data.Results A total of 2015 clinical isolates were collected.Among them there were 1332 gram-negative bacilli isolates(66.1%);683 gram-positive bacilli isolates(33.9%).According to the isolate rate,the top five pathogenic bacteria were:Escherichia coli(27.9%),Klebsiella pneumoniae(11.3%),Staphylococcus aureus(10.9%),Pseudomonas aeruginosa(7.0%)and Acinetobacter baumannii(6.0%).The antibacterial medicines with relatively high sensitivities to the gram-negative bacilli of the bloodstream infection were:Tigecycline(98.2% excluding Pseudomonas aeruginosa),Polymyxine(98.1%,non-fermentative bacteria),Ceftazidine/Clavulanate(90.4%)in order.The antibacterial medicines with relatively high sensitivities to the gram-positive bacilli of the bloodstream infection were:Tigecycline and Linezolid(Sensitivities of both were 100%),Vancomycin and Teicoplanin(Sensitivities of both were 99.4%).The data indicated that the incidence of oxacillin-resistant Staphylococcus aureus(MRSA) was 42.3% and 42.2% in 2007 and 2009 respectively.The incidence of Enterobacteriaceae producing extended-spectrum β-Lactamases(ESBL) was 54.7% and 53.4% in 2007 and 2009 respectively.The incidence of Multidrug Resistant Acinetobacter baumannii(MDRA) was 49.0% and 64.8% in 2007 and 2009 respectively;The incidences of High Level Gentamicin Resistance (HLGR) of Enterobacteriaceae faecalis and Enterobacteriaceae faecium are 62.6% and 66.7% in 2007 and 2009 respectively; The incidences of Carbapenem insensitivity of Enterobacteriaceae faecalis and Enterobacteriaceae faecium are 2.1% and 4.6% in 2007 and 2009 respectively.Conclusions Gram-negative bacilli(Escherichia coli and Klebsiella pneumoniae mainly)are the major pathogens of nosocomial bloodstream infection,to which Tigecycline and Carbapenems are most sensitive.Among gram-positive bacilli,Staphylococcus aureus has the highest isolation rate,followed by Enterococcus faecium,to which Tigecycline,Linezolid,Vancomycin and Teicoplanin have higher sensitivities.The drug-resistance rates of MDRA,HLGR,MDRP and Carbapenem insensitive Enterobacteriaceae have risen by 15.8%,4.1%,4.0% and 2.5% respectively,which should be paid attention to in the clinical treatments.更多还原