2012年上海地区细菌耐药性监测
2012년상해지구세균내약성감측
Surveillance of bacterial resistance from hospitals in Shanghai in 2012
  • 万方数据
    中国感染与化疗杂志 중국감염여화료잡지
    CHINESE JOURNAL OF INFECTION AND CHEMOTHERAPY
    2013年 6期 409-419 ,共11页

    朱德妹%汪复%郭燕%杨洋%蒋晓飞%王传清%王爱敏%刘瑛%陈峰%倪语星%孙景勇%王靖%李虎%汤瑾%王坚镪%应春妹%汪雅萍%张泓%孔菁%魏丽%王金铎%袁应华%刘妍%胡必杰%黄声雷%陈险峰%殷杏%刘庆中%汤荣%袁轶群%武楠%傅启华%黄卫春%杨海慧%卫颖珏%孙康德%虞中敏%唐群力%冯景%康向东%戴俊华%张正银%孙晴%孙杰%沈思娣%秦云%钱敏健%王蓉%沈燕雅%彭敬红%刘军%朱祖怀%陈超%唐之俭%王芳%汪瑞忠%房华%范惠清%严育忠%朱学源%龚炜

    주덕매%왕복%곽연%양양%장효비%왕전청%왕애민%류영%진봉%예어성%손경용%왕정%리호%탕근%왕견강%응춘매%왕아평%장홍%공정%위려%왕금탁%원응화%류연%호필걸%황성뢰%진험봉%은행%류경중%탕영%원질군%무남%부계화%황위춘%양해혜%위영각%손강덕%우중민%당군력%풍경%강향동%대준화%장정은%손청%손걸%침사제%진운%전민건%왕용%침연아%팽경홍%류군%주조부%진초%당지검%왕방%왕서충%방화%범혜청%엄육충%주학원%공위

    细菌耐药性%抗菌药物%药敏试验%泛耐药菌 細菌耐藥性%抗菌藥物%藥敏試驗%汎耐藥菌
    세균내약성%항균약물%약민시험%범내약균
    bacterial resistance%antimicrobial agent%bacterial susceptibility testing%pandrug-resistant microorganism
    目的：了解2012年上海市细菌耐药性监测结果。方法采用纸片扩散法（K-B 法）对上海地区29所医院的临床分离菌进行药敏试验，其中包括17所三级医院和12所二级医院。采用 CLSI 2012年版标准判断结果。结果总计76407株临床分离菌，革兰阳性菌占26．6％，革兰阴性菌占73．4％。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）的平均检出率分别为52．1％和77．0％。MRSA和 MRCNS 在二级医院和三级医院的平均检出率分别为67．3％、82．9％和48．3％、76．1％。葡萄球菌属中未发现万古霉素、替考拉宁和利奈唑胺耐药株。685株儿童非脑膜炎分离株中青霉素敏感、中介和耐药肺炎链球菌（PSSP 、PISP 和 PRSP）的检出率分别为72．7％、13．7％和13．6％，75株成人分离株的检出率分别为92．0％、5．3％和2．7％。发现万古霉素耐药屎肠球菌26株、粪肠球菌3株。首次在二级医院中发现万古霉素耐药粪肠球菌2株、屎肠球菌4株。根据表型推测，多数万古霉素耐药肠球菌（VRE）为Van A 基因型。大肠埃希菌、克雷伯菌属（肺炎克雷伯菌和产酸克雷伯菌）和奇异变形杆菌中产 ESBLs 的检出率分别为60．1％、35．8％和38．9％。上述3种细菌中的 ESBLs 菌株的检出率在二级医院和三级医院的检出率分别为65．6％、32．5％、51．5％和58．7％、36．6％、32．8％。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感，对亚胺培南和美罗培南的总耐药率分别为6．1％和4．1％。铜绿假单胞菌、不动杆菌属对亚胺培南和美罗培南耐药率分别为28．4％、23．2％和50．6％、55．1％。大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中有少数菌株对所有测试药物耐药的泛耐药株（替加环素和多黏菌素未测）。分离自尿液标本中的肠球菌属细菌和大肠埃希菌对磷霉素的耐药率低。结论细菌耐药性仍对临床构成严重威胁，尤其是二级医院中某些细菌的耐药率高于三级医院，应引起严重关注。
    목적：료해2012년상해시세균내약성감측결과。방법채용지편확산법（K-B 법）대상해지구29소의원적림상분리균진행약민시험，기중포괄17소삼급의원화12소이급의원。채용 CLSI 2012년판표준판단결과。결과총계76407주림상분리균，혁란양성균점26．6％，혁란음성균점73．4％。내갑양서림금포균（MRSA）화내갑양서림응고매음성포도구균（MRCNS）적평균검출솔분별위52．1％화77．0％。MRSA화 MRCNS 재이급의원화삼급의원적평균검출솔분별위67．3％、82．9％화48．3％、76．1％。포도구균속중미발현만고매소、체고랍저화리내서알내약주。685주인동비뇌막염분리주중청매소민감、중개화내약폐염련구균（PSSP 、PISP 화 PRSP）적검출솔분별위72．7％、13．7％화13．6％，75주성인분리주적검출솔분별위92．0％、5．3％화2．7％。발현만고매소내약시장구균26주、분장구균3주。수차재이급의원중발현만고매소내약분장구균2주、시장구균4주。근거표형추측，다수만고매소내약장구균（VRE）위Van A 기인형。대장애희균、극뢰백균속（폐염극뢰백균화산산극뢰백균）화기이변형간균중산 ESBLs 적검출솔분별위60．1％、35．8％화38．9％。상술3충세균중적 ESBLs 균주적검출솔재이급의원화삼급의원적검출솔분별위65．6％、32．5％、51．5％화58．7％、36．6％、32．8％。장간균과세균대탄청매희류항생소잉고도민감，대아알배남화미라배남적총내약솔분별위6．1％화4．1％。동록가단포균、불동간균속대아알배남화미라배남내약솔분별위28．4％、23．2％화50．6％、55．1％。대장애희균、폐염극뢰백균、포만불동간균화동록가단포균중유소수균주대소유측시약물내약적범내약주（체가배소화다점균소미측）。분리자뇨액표본중적장구균속세균화대장애희균대린매소적내약솔저。결론세균내약성잉대림상구성엄중위협，우기시이급의원중모사세균적내약솔고우삼급의원，응인기엄중관주。
    Objective To investigate the resistance of clinical bacterial isolates to antibiotics in Shanghai hospitals from Jonuary through December in 2012.Methods Antimicobial susceptibility testing was carried out for the clinical isolates from 29 hospitals according to an agreed protocol using Kirby-Bauer (K-B)method.Results were analyzed according to CLSI 2012 breakpoints. Results Of the 76 407 clinical isolates,gram positive cocci and gram negative bacilli accounted for 26.6% and 73.4 %,respec-tively.The overall prevalence of MRSA in Staphylococcus aureus was 52.1% and 77.0% for MRCNS in coagulase-negative Staphylococcus.The average prevalence of MRSA and MRCNS was 67.3% and 82.9% in secondary hospitals,48.3% and 76.1% in tertiary hospitals.No strains were found resistant to vancomycin,teicoplanin or linezolid.About 72.7% of the 685 strains of non-meningitis S.pneumoniae isolated from children were penicillin-susceptible (PSSP),27.3% were penicillin-non-susceptible,including penicillin-intermediate (PISP,13.7%)and penicillin-resistant (PRSP,13.6%)strains.Of the 75 strains isolated from adults,92.0%,5.3% and 2.7% were PSSP,PISP and PRSP,respectively.Overall,26 strains of vaco-mycin-resistant E.feacium and 3 strains of vacomycin-resistant E.feacalis were identified.Most of these resistant strains were VanA type based on their phenotype.Two strains of vancomycin-resistant E.faecalis and 4 strains of vancomycin-resist-ant E.feacium were reported in the secondary hospitals for the first time.The overall prevalence of ESBLs-producing srains was 60.1% in E.coli,35.8% in Klebsiella spp.(K .pneumoniae and K .oxytoca)and 38.9% in P .mirabilis.Specifically, the prevalence of such strains was 65.6%,32.5% and 51.5% in secondary hospitals,58.7%,36.6% and 32.8% in tertiary hospitals,respectively.Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics.Overall,6.1% and 4.1% of the Enterobacteriaceae strains were resistant to imipenem and meropenem,respectively.Of the Acinetobacter spp. strains,50.6% and 55.1% were resistant to imipenem and meropenem,respectively.Of the P .aeruginosa strains,28.4%and 23.2% were resistant to imipenem and meropenem,respectively.A few pan-drug resistant strains were identified in E.co-li,K.pneumoniae,A.baumannii and P .aeruginosa.The strains of Enterococcus spp.and E.coli isolated from urine showed relatively lower resistance to fosfomycin.Conclusions It seems that antibicotic resistance is increasing in the clinical isolates, which poses a serious threat to the clinical practice.Special attention should be paid to the fact that the prevalence of resistant strains of some species in secondary hospitals is even higher than that in tertiary hospitals.
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