2009年中国13家教学医院院内感染病原菌的抗生素耐药性监测
2009년중국13가교학의원원내감염병원균적항생소내약성감측
Antimicrobial resistance surveillance among nosocomial pathogens in 13 teaching hospitals in China in 2009
  • 万方数据
    中华检验医学杂志 중화검험의학잡지
    CHINESE JOURNAL OF LABORATORY MEDICINE
    2011年 5期 422-430 ,共9页

    杨启文%王辉%徐英春%陈民钧%苏丹虹%胡志东%廖康%曾吉%王勇%曹彬%褚云卓%张嵘%刘文恩%周春妹%宁永忠%徐修礼%卓超%田彬%陈冬梅%熊艳%李平%刘颖梅%年华%李丽红%邹明祥%谢红梅%杨佩红%孙宏莉%谢秀丽

    양계문%왕휘%서영춘%진민균%소단홍%호지동%료강%증길%왕용%조빈%저운탁%장영%류문은%주춘매%저영충%서수례%탁초%전빈%진동매%웅염%리평%류영매%년화%리려홍%추명상%사홍매%양패홍%손굉리%사수려

    抗药性,细菌%交叉感染%微生物敏感性试验%药物监测 抗藥性,細菌%交扠感染%微生物敏感性試驗%藥物鑑測
    항약성,세균%교차감염%미생물민감성시험%약물감측
    Drug resistance,bacterial%Cross infection%Microbial sensitivity tests%Drug Monitoring
    目的 监测2009年我国不同地区13家教学医院院内获得病原菌的分布和体外药物敏感性.方法 收集来自13家医院院内BSI、HAP和IAI患者标本的病原菌.菌株经中心实验室复核后,采用琼脂稀释法测定替加环素等抗菌药物的MIC值,数据输入WHONET5.6软件进行耐药性分析.结果 共收集到2 502株病原菌.引起BSI的前3位病原菌分别为大肠埃希菌[27.1%(285/1 052)]、凝固酶阴性葡萄球菌[12.6%(133/1 052)]和肺炎克雷伯菌[10.8%(114/1 052)];引起HAP的前3位病原菌分别为鲍曼不动杆菌[28.8%(226/785)]、铜绿假单胞菌[16.1%(126/785)]和肺炎克雷伯菌[14.6%(115/785)];而IAI的主要病原菌为大肠埃希菌[31.0%(206/665)]、肺炎克雷伯菌[11.3%(75/665)]和屎肠球菌[10.8%(72/665)].对于大肠埃希菌和克雷伯菌,敏感率大于80%的药物包括亚胺培南和美罗培南(98.1%～100%)、替加环素(95.3%～100%)、哌拉西林-三唑巴坦(88.6%～97.1%)和阿米卡星(88.3%～92.5%).对于肠杆菌属、柠檬酸杆菌属和沙雷菌属,替加环素的敏感率为93.5%～100%,亚胺培南和美罗培南的敏感率为92.9%～100%,敏感率较高的抗萧药物还包括阿米卡星(85.2%～96.7%)、哌拉西林-三唑巴坦(82.4%～96.4%)、头孢吡肟(79.6%～96.7%)和头孢哌酮-舒巴坦(78.7%～90.0%).铜绿假单胞菌对多黏菌素B的敏感率最高(100%),其次为阿米卡星和哌拉西林-三唑巴坦(81.9%和80.1%).鲍曼不动杆菌对多黏菌素B的敏感率最高(98.8%),其次为替加环素(90.1%)和米诺环素(72.O%).CRAB的发生率为60.1%.金黄色葡萄球菌中MRSA的发生率为60.2%,凝固酶阴性葡萄球菌中MRSCoN的发生率为84.2%.所有葡萄球菌对替加环素、万占霉素和利奈唑胺敏感,仅有1株溶血葡萄球菌对替考拉宁中介.本次监测发现2株利奈唑胺中介的粪肠球菌和1株万古霉素和替考拉宁耐药的屎肠球菌,替加环素对这3株肠球菌的MIC值范围为0.032～0.064μg/ml.结论 替加环素、碳青霉烯类、哌拉西林-三唑巴坦、阿米卡星和头孢吡肟对医院分离的肠杆菌科菌保持了较高的抗菌活性;多黏菌素B对铜绿假单胞菌和鲍曼不动杆菌体现出高抗菌活性,替加环素对鲍曼不动杆菌抗菌活性较高;替加环素、万古霉素和替考拉宁、利奈唑胺对院内获得革兰阳性球菌保持了较高的抗菌活性.
    목적 감측2009년아국불동지구13가교학의원원내획득병원균적분포화체외약물민감성.방법 수집래자13가의원원내BSI、HAP화IAI환자표본적병원균.균주경중심실험실복핵후,채용경지희석법측정체가배소등항균약물적MIC치,수거수입WHONET5.6연건진행내약성분석.결과 공수집도2 502주병원균.인기BSI적전3위병원균분별위대장애희균[27.1%(285/1 052)]、응고매음성포도구균[12.6%(133/1 052)]화폐염극뢰백균[10.8%(114/1 052)];인기HAP적전3위병원균분별위포만불동간균[28.8%(226/785)]、동록가단포균[16.1%(126/785)]화폐염극뢰백균[14.6%(115/785)];이IAI적주요병원균위대장애희균[31.0%(206/665)]、폐염극뢰백균[11.3%(75/665)]화시장구균[10.8%(72/665)].대우대장애희균화극뢰백균,민감솔대우80%적약물포괄아알배남화미라배남(98.1%～100%)、체가배소(95.3%～100%)、고랍서림-삼서파탄(88.6%～97.1%)화아미잡성(88.3%～92.5%).대우장간균속、저몽산간균속화사뢰균속,체가배소적민감솔위93.5%～100%,아알배남화미라배남적민감솔위92.9%～100%,민감솔교고적항소약물환포괄아미잡성(85.2%～96.7%)、고랍서림-삼서파탄(82.4%～96.4%)、두포필우(79.6%～96.7%)화두포고동-서파탄(78.7%～90.0%).동록가단포균대다점균소B적민감솔최고(100%),기차위아미잡성화고랍서림-삼서파탄(81.9%화80.1%).포만불동간균대다점균소B적민감솔최고(98.8%),기차위체가배소(90.1%)화미낙배소(72.O%).CRAB적발생솔위60.1%.금황색포도구균중MRSA적발생솔위60.2%,응고매음성포도구균중MRSCoN적발생솔위84.2%.소유포도구균대체가배소、만점매소화리내서알민감,부유1주용혈포도구균대체고랍저중개.본차감측발현2주리내서알중개적분장구균화1주만고매소화체고랍저내약적시장구균,체가배소대저3주장구균적MIC치범위위0.032～0.064μg/ml.결론 체가배소、탄청매희류、고랍서림-삼서파탄、아미잡성화두포필우대의원분리적장간균과균보지료교고적항균활성;다점균소B대동록가단포균화포만불동간균체현출고항균활성,체가배소대포만불동간균항균활성교고;체가배소、만고매소화체고랍저、리내서알대원내획득혁란양성구균보지료교고적항균활성.
    Objective To investigate distribution and antimicrobial resistance among nosocomial pathogens from 13 teaching hospitals in China in 2009. Methods Non-repetitive pathogens from nosocomial BSI, HAP and IAI were collected and sent to the central lab for MIC determination by agar dilution method.WHONET5.6 software was used to analyze the data. Results A total of 2 502 clinical isolates were collected. The top three pathogens of BSI were Escherichia coli [27. 1% (285/1 052 )] , coagulase-negutive staphylococcus [12. 6% ( 133/1 052)] and Klebsiella pneumoniae [10. 8% ( 114/1 052)]. The top three pathogens of HAP were Acinetobacter baumannii [28. 8% (226/785)], Pseudomonas aeruginosa [16. 1% (126/785)] and Klebsiella pneumoniae [14.6% (115/785 )] . The top three pathogens of IAI were Escherichia coli[31.0% ( 206/665 )], Klebsiella pneumonia [11.3% ( 75/665 )] and Enterococcus faecium [10. 8% (72/665)]. Against Escherichia coil and Klebsiella spp. , the antimicrobial agents with higher than 80% susceptibility rate included imipenem and meropenem (98. 1%-100% ), tigecycline (95.3%-100% ), piperacillin-tazobactam ( 88.6% -97. 1% ) and amikacin ( 88. 3% -92. 5% ). Against Enterobacter spp. , Citrobacter spp. and Serratia spp. , the susceptibility rates of tigecycline were 93.5% -100% whereas the value of imipenem and meropenem were 92.9% -100%. Other antimicrobial agents with high activity included amikacin ( 85.2% -96. 7% ), pipcracillin-tazobactam ( 82.4% -96.4% ), cefepime ( 79. 6% -96. 7% ) and cefoperazonc-sulbactam (78. 7%-90. 0% ). Polymyxin B showed the highest susceptibility rateagainst Pseudomonas aeruginosa ( 100% ), followed by amikacin ( 81.9% ) and piperacillin-tazobactam (80.1% ). Polymyxin B also showed the highest susceptibility rate against Acinetobacter baumannii (98. 8% ), followed by tigecycline (90. 1% ) and minocycline (72. 0% ). The incidence of carbapenemresistant Acinetobacter baumannii was 60. 1%. The MRSA rate was 60. 2% and the MRSCoN rate was 84. 2%. All Staphylococcus strains were susceptible to tigecycline, vancomycin, teicoplanin and linezolid except for one isolate of Staphylococcus haemolysis with intermediate to teicoplanin. Two Enterococcus faecalis isolates which were intermediate to linezolid and one Enterococcus faecium isolate which was resistant to vancomycin and teicoplanin was found in this surveillance, while the MICs of tigecycline against these three isolates were 0. 032-0. 064 μg/ml. Conclusions Tigecycline, carbapenems, piperacillin-tazobactam,amikacin and cefepime remain relatively high activity against nosocomial Enterobacteriaceae. Pseudomonas aeruginosa exhibite high susceptibility to polymyxin B, while Acinetobacter baumanni shows high susceptibility to polymyxin B and tigecycline. Tigecycline, vancomycin, teicoplanin and linezolid remain high activity against nosocomial gram-positive cocci.
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