我国2009至2010年MOHNARIN项目临床分离常见病原菌的耐药监测
아국2009지2010년MOHNARIN항목림상분리상견병원균적내약감측
Antimicrobial susceptibility surveillance in China: a MOHNARIN program report (2009-2010)
  • 万方数据
    中华检验医学杂志 중화검험의학잡지
    CHINESE JOURNAL OF LABORATORY MEDICINE
    2012年 1期 67-87 ,共21页

    李耘%吕媛%薛峰%刘健%郑波%张秀珍%胡云建%于庭%褚云卓%胡志东%赵建宏%潘世扬%赵旺胜%胡必杰%邓秋连%杨健%李艳%刘文恩%周玲%董方%府伟灵%徐修礼%裴凤艳%孟灵%季萍%李曼宁%杨维维%张佳

    리운%려원%설봉%류건%정파%장수진%호운건%우정%저운탁%호지동%조건굉%반세양%조왕성%호필걸%산추련%양건%리염%류문은%주령%동방%부위령%서수례%배봉염%맹령%계평%리만저%양유유%장가

    抗药性,细菌%微生物敏感性试验%肠杆菌科%葡萄球菌,金黄色 抗藥性,細菌%微生物敏感性試驗%腸桿菌科%葡萄毬菌,金黃色
    항약성,세균%미생물민감성시험%장간균과%포도구균,금황색
    Drug resistance,bacterial%Microbial sensitivity tests%Enterobacteriaceae%Staphyloccocus aureus
    目的 监测我国主要城市三级甲等医院住院患者的细菌耐药状况,了解临床分离病原菌分布及耐药趋势.方法 定点收集来自全国17座城市19家医院的6507株临床分离细菌,4691株分离白研究病房,1816株分离自研究病房以外.由中心实验室采用美国临床和实验室标准协会(Clinical and Laboratory Standards Institute,CLSI)推荐的琼脂二倍稀释法测定抗菌药物最低抑菌浓度值.采用统计软件SPSS 17.0计算MIC50、MIC90和MIC范围,并根据CLSI 2010颁布抗菌药物临界浓度标准进行耐药分析.结果 来自研究病房的4691株细菌中,革兰阳性菌1156株,占24.6％,革兰阴性菌3535株,占75.4％.最低抑菌浓度检测结果显示,甲氧西林耐药金黄色葡萄球菌和甲氧西林耐药表皮葡萄球菌检出率分别为51.6％(325/630)和87.0％ (228/262),未发现对万古霉素中介或耐药的葡萄球菌.凝固酶阴性葡萄球菌对替考拉宁有2.5％( 16/642)的中介率和1.6％( 10/642)的耐药率,对利奈唑胺耐药率为0.5％ (3/642).粪肠球菌对氨苄西林耐药率为17.1％(19/111),屎肠球菌则高达85.0％ (164/193)；发现3株对糖肽类耐药的屎肠球菌,耐药率1.5％(3/193).青霉素耐药肺炎链球菌和青霉素中介肺炎链球菌的检出率按口服青霉素标准判定分别为41.2％( 145/352)和37.2％(131/352);按静脉对非脑膜炎标准判定分别为0.0％( 0/352)和6.0％(21/352).肠杆菌科细菌对碳青霉烯类抗生素仍保持很高的敏感性,耐药率基本小于2.0％,此外,替加环素、拉氧头孢、磷霉素、阿米卡星也具有很好的抗菌活性,耐药率均在10.0％以下.非发酵革兰阴性菌中铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为23.1％(139/601)和53.5％(419/784),其中鲍曼不动杆菌耐药率较2007至2008年的监测结果有明显增加.多黏菌素、替加环素、米诺环素和磷霉素对鲍曼不动杆菌表现出较好的体外抗菌作用.结论 与以往的监测结果比较,除鲍曼不动杆菌耐药率增长较明显外,其他菌种(属)耐药状况稳定.利奈唑胺、替加环素等新抗菌药物中,也已发现耐药菌株.细菌耐药不容忽视,合理用药不容疏忽.
    목적 감측아국주요성시삼급갑등의원주원환자적세균내약상황,료해림상분리병원균분포급내약추세.방법 정점수집래자전국17좌성시19가의원적6507주림상분리세균,4691주분리백연구병방,1816주분리자연구병방이외.유중심실험실채용미국림상화실험실표준협회(Clinical and Laboratory Standards Institute,CLSI)추천적경지이배희석법측정항균약물최저억균농도치.채용통계연건SPSS 17.0계산MIC50、MIC90화MIC범위,병근거CLSI 2010반포항균약물림계농도표준진행내약분석.결과 래자연구병방적4691주세균중,혁란양성균1156주,점24.6％,혁란음성균3535주,점75.4％.최저억균농도검측결과현시,갑양서림내약금황색포도구균화갑양서림내약표피포도구균검출솔분별위51.6％(325/630)화87.0％ (228/262),미발현대만고매소중개혹내약적포도구균.응고매음성포도구균대체고랍저유2.5％( 16/642)적중개솔화1.6％( 10/642)적내약솔,대리내서알내약솔위0.5％ (3/642).분장구균대안변서림내약솔위17.1％(19/111),시장구균칙고체85.0％ (164/193)；발현3주대당태류내약적시장구균,내약솔1.5％(3/193).청매소내약폐염련구균화청매소중개폐염련구균적검출솔안구복청매소표준판정분별위41.2％( 145/352)화37.2％(131/352);안정맥대비뇌막염표준판정분별위0.0％( 0/352)화6.0％(21/352).장간균과세균대탄청매희류항생소잉보지흔고적민감성,내약솔기본소우2.0％,차외,체가배소、랍양두포、린매소、아미잡성야구유흔호적항균활성,내약솔균재10.0％이하.비발효혁란음성균중동록가단포균화포만불동간균대아알배남적내약솔분별위23.1％(139/601)화53.5％(419/784),기중포만불동간균내약솔교2007지2008년적감측결과유명현증가.다점균소、체가배소、미낙배소화린매소대포만불동간균표현출교호적체외항균작용.결론 여이왕적감측결과비교,제포만불동간균내약솔증장교명현외,기타균충(속)내약상황은정.리내서알、체가배소등신항균약물중,야이발현내약균주.세균내약불용홀시,합리용약불용소홀.
    Objective To investigate the bacterial resistance in nationwide and understand the distribution of bacterial and resistance trend.Methods The 6507 clinical isolates were collected from 19 hospitals in 17 cities.The susceptibility tests were performed using agar dilution method recommended by Clinical and Laboratory Standards Institute (CLSI) in central laboratory.The values of MIC50,MIC90 and MICrange were calculated by SPSS 17.0 and the susceptibilities of isolates to antimicrobial agents were determined by using CLSI (2010) guideline.Of all 6507 isolates,4691 strains were collected from target wards and 1816 were isolated from others wards.Results Among 4691 strains,1156 were Gram-positive (24.6％ ) and 3535 were Gram-negative (75.4％).Based on the minimum inhibitory concentration results,the prevalence of methicillin resistant Stapylococcus aureus and methicillin resistant Stapylococcus epidermidis are 51.6％ ( 325/630 ) and 87.0％ ( 228/262 ) respectively.Staphylococci showing intermediate or full resistance to vancomycin were not observed. Coagulase negative Staphylococci showed 2.5％ (16/642)intermediate rate and 1.6％ ( 10/642 ) full resistance rate to teicoplanin,and showed 0.5％ ( 3/642 )resistance rate to linezolid.Antibiotic resistance rate of Enterococcus faecalis to ampicillin was 17.1％(19/111),while the resistance rate of Enterococcus faecium to ampicillin reached up to 85.0％(164/193).Three Enterococcus faecium were resistant to glycopeptides.The prevalence of penicillin resistance Streptococcus pneumoniae and penicillin intermediate Streptococcus pneumoniae were 41.2％ ( 145/352) and 37.2％ (131/352) respectively based on oral penicillin criterion,while the prevalence were 0.0％ (0/352) and 6.0％ (21/352) based on vein to non-meningitis criterion.A vast majority of Enterobacteriaceae maintained high susceptibility to carbapenems,with resistance rate less than 2.0％.In addition,tigecycline,moxalactam,fosfomycin and amikacin displayed desirable antibacterial activity against Enterbacteriaceae,and resistance rates to these drugs were all less than 10.0％.For non-fermenting Gramnegative isolates,resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 23.1％ ( 139/601 ) and 53.5％ (419/784) respectively.Resistance rate of Acinetobacter baumannii was much higher than that during the period 2007 - 2008.Colistin,tigecycline,minocycline and fosfomycin demonstrated good antibacterial activity against Acinetobacter baumannii in vitro.Conclusions Compared with MOHNARIN 2007 -2008 year surveillance results, significant increase in resistance rate of Acinetobacter baumannii was demonstrated.Resistant strains to linezolid and tigecycline were found.Bacterial resistance has been a widespread problem in our country,which requires much more attention.
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