中国感染与化疗杂志
中國感染與化療雜誌
중국감염여화료잡지
CHINESE JOURNAL OF INFECTION AND CHEMOTHERAPY
2014年
2期
104-111
,共8页
张小江%张辉%窦红涛%朱任媛%谢秀丽%王澎%赵颖%宋红梅%王贺%王瑶%杨启文%孙宏莉%陈雨%徐英春
張小江%張輝%竇紅濤%硃任媛%謝秀麗%王澎%趙穎%宋紅梅%王賀%王瑤%楊啟文%孫宏莉%陳雨%徐英春
장소강%장휘%두홍도%주임원%사수려%왕팽%조영%송홍매%왕하%왕요%양계문%손굉리%진우%서영춘
细菌耐药性监测%抗菌药物%泛耐药菌%药敏试验
細菌耐藥性鑑測%抗菌藥物%汎耐藥菌%藥敏試驗
세균내약성감측%항균약물%범내약균%약민시험
bacterial resistance surveillance%antimicrobial agent%pan-resistant bacteria%antimicrobial susceptibility testing
目的：了解北京协和医院2012年临床分离细菌对抗菌药物的耐药性。方法共收集6662株非重复的细菌，采用纸片扩散法或自动化仪器法进行药敏试验，结果按 CLSI 2012年版标准判读，采用 WHONET5．6软件进行数据分析。结果6662株非重复的细菌中革兰阴性菌4446株，占66．7％，革兰阳性菌2216株，占33．3％。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）的检出率分别为39．9％和73．4％。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌属。发现少数对万古霉素和替考拉宁耐药的粪肠球菌和屎肠球菌，未发现对利奈唑胺耐药的肠球菌属。产ESBLs的大肠埃希菌、克雷伯菌属细菌（肺炎克雷伯菌和产酸克雷伯菌）和奇异变形杆菌的检出率分别为53．0％、25．7％和27．0％。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感，总耐药率为1．1％～2．6％。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为20．3％和13．6％。鲍曼不动杆菌对上述2种抗菌药物的耐药率分别为72．8％和75．2％。泛耐药鲍曼不动杆菌的检出率为43．5％（330/759）。结论细菌对抗菌药物的耐药性呈增高趋势，特别是泛耐药的鲍曼不动杆菌，应采取有效的医院感染防控措施和合理使用抗菌药物。
目的：瞭解北京協和醫院2012年臨床分離細菌對抗菌藥物的耐藥性。方法共收集6662株非重複的細菌，採用紙片擴散法或自動化儀器法進行藥敏試驗，結果按 CLSI 2012年版標準判讀，採用 WHONET5．6軟件進行數據分析。結果6662株非重複的細菌中革蘭陰性菌4446株，佔66．7％，革蘭暘性菌2216株，佔33．3％。耐甲氧西林金葡菌（MRSA）和耐甲氧西林凝固酶陰性葡萄毬菌（MRCNS）的檢齣率分彆為39．9％和73．4％。未髮現對萬古黴素、替攷拉寧和利奈唑胺耐藥的葡萄毬菌屬。髮現少數對萬古黴素和替攷拉寧耐藥的糞腸毬菌和屎腸毬菌，未髮現對利奈唑胺耐藥的腸毬菌屬。產ESBLs的大腸埃希菌、剋雷伯菌屬細菌（肺炎剋雷伯菌和產痠剋雷伯菌）和奇異變形桿菌的檢齣率分彆為53．0％、25．7％和27．0％。腸桿菌科細菌對碳青黴烯類抗生素仍高度敏感，總耐藥率為1．1％～2．6％。銅綠假單胞菌對亞胺培南和美囉培南的耐藥率分彆為20．3％和13．6％。鮑曼不動桿菌對上述2種抗菌藥物的耐藥率分彆為72．8％和75．2％。汎耐藥鮑曼不動桿菌的檢齣率為43．5％（330/759）。結論細菌對抗菌藥物的耐藥性呈增高趨勢，特彆是汎耐藥的鮑曼不動桿菌，應採取有效的醫院感染防控措施和閤理使用抗菌藥物。
목적：료해북경협화의원2012년림상분리세균대항균약물적내약성。방법공수집6662주비중복적세균，채용지편확산법혹자동화의기법진행약민시험，결과안 CLSI 2012년판표준판독，채용 WHONET5．6연건진행수거분석。결과6662주비중복적세균중혁란음성균4446주，점66．7％，혁란양성균2216주，점33．3％。내갑양서림금포균（MRSA）화내갑양서림응고매음성포도구균（MRCNS）적검출솔분별위39．9％화73．4％。미발현대만고매소、체고랍저화리내서알내약적포도구균속。발현소수대만고매소화체고랍저내약적분장구균화시장구균，미발현대리내서알내약적장구균속。산ESBLs적대장애희균、극뢰백균속세균（폐염극뢰백균화산산극뢰백균）화기이변형간균적검출솔분별위53．0％、25．7％화27．0％。장간균과세균대탄청매희류항생소잉고도민감，총내약솔위1．1％～2．6％。동록가단포균대아알배남화미라배남적내약솔분별위20．3％화13．6％。포만불동간균대상술2충항균약물적내약솔분별위72．8％화75．2％。범내약포만불동간균적검출솔위43．5％（330/759）。결론세균대항균약물적내약성정증고추세，특별시범내약적포만불동간균，응채취유효적의원감염방공조시화합리사용항균약물。
Objective To investigate the profile of antimicrobial resistance in clinical isolates from the patients in Peking Union Medical College Hospital during 2012.Methods A total of 6 662 nonduplicate clinical isolates were collected.Disc diffusion test or Kirby-Bauer method and automated systems were employed to study the antimicrobial resistance.The data were analyzed by WHONET 5.6 software according to CLSI 2012 breakpoints.Results Of the 6 662 bacterial strains included in this analysis, gram negative organisms and gram positive cocci accounted for 66.7% (4 446/6 662)and 33.3% (2 216/6 662),respectively. The top 10 most frequently isolated microorganisms were E.coli (17%),P .aeruginosa (11.4%),A.baumannii (11.4%), S.aureus (11.2%),K.pneumoniae (9.2%),E.faecalis (8.4%),E.faecium (4.1%),coagulase negative Staphylococcus (3.3%),E.cloacae (3.1%)and S.maltophilia (3.1%).About 39.9% of the S.aureus strains and 73.4% of the coagulase negative Staphylococcus were methicillin-resistant.No staphylococcal strains were found resistant to vancomycin,teicoplanin or linezolid.A few of vancomycin-or teicoplanin-resistant strains were identified in both E.faecium and E.faecalis.No lin-ezolid resistant strains were found.ESBLs-producing strains accounted for 53.0%,25.7% and 27.0% in E.coli,Klebsiella spp.(K.pneumoniae and K.oxytoca)and P .mirabilis, respectively.The Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 2.6% of these strains were resistant to carbapenems.A few pan-re-sistant strains of K.pneumoniae (0.7%,4/615)were iden-tified.About 20.3% and 13.6% of the P .aeruginosa isolates were resistant to imipenem and meropenem,respectively.P . aeruginosa isolates showed the lowest resistance rate (7.2%)to amikacin.And 72.8% and 75.2% of A.baumannii strains were resistant to imipenem and meropenem.A.baumannii isolates showed relatively low resistance rate to cefoperazone-sulbac-tam (51.2%)and minocycline (30.2%).The prevalence of pan-resistant strains was 43.5% in A.baumannii and 1.4% in P . aeruginosa.Conclusions Bacterial resistance is still increasing,especially pan-resistant A.baumannii strains.It is mandatory to take effective measures to control hospital infections and improve rational antibiotic use.
