中华微生物学和免疫学杂志
中華微生物學和免疫學雜誌
중화미생물학화면역학잡지
CHINESE JOURNAL OF MICROBIOLOGY AND IMMUNOLOGY
2013年
6期
401-409
,共9页
郭宇%王辉%赵春江%王占伟%曹彬%徐英春%胡必杰%倪语星%张莉滟
郭宇%王輝%趙春江%王佔偉%曹彬%徐英春%鬍必傑%倪語星%張莉滟
곽우%왕휘%조춘강%왕점위%조빈%서영춘%호필걸%예어성%장리염
细菌耐药%抗生素%革兰阳性球菌
細菌耐藥%抗生素%革蘭暘性毬菌
세균내약%항생소%혁란양성구균
Antimicrobial resistance%Anti-bacterial drugs%Gram-positive cocci
目的 调查2012年我国16家医院革兰阳性球菌临床分离株的耐药率.方法 收集2012年6至12月16家教学医院临床分离的1790株非重复革兰阳性球菌.采用琼脂稀释法测定抗菌药物的MIC,回顾性研究不同病原菌对临床常用抗菌药物的耐药率,采用一般x2检验比较不同年龄组中耐甲氧西林金黄色葡萄球菌(MRSA)和耐青霉素肺炎链球菌(PRSP)的发生率.结果 MRSA和耐甲氧西林凝固酶阴性葡萄球菌(MRCoNS)的发生率分别为43.6％ (264/605)和75.7％ (227/300),不同地区MRSA发生率为20.5％ ～ 60.9％,不同标本中MRSA发生率为:呼吸道标本54.4％(106/195)、血液标本43.6％(58/133)、伤口组织及脓液标本29.8％(56/188),老年组中MRSA发生率(53.9％,110/204)高于成人组(41.4％,149/360)(P＜0.05).MRSA对氯霉素和复方新诺明的敏感率分别为92.4％(244/264)和89.8％(237/264),对庆大霉素、红霉素、克林霉素、四环素、利福平和喹诺酮类药物的敏感率为12.5％～51.9％,发现1株对万古霉素中介的金黄色葡萄球菌(VISA),万古霉素MIC值为3μg/ml.未发现对替考拉宁、万古霉素、利奈唑胺和达托霉素耐药的金黄色葡萄球菌.PRSP在幼儿组中的发生率为61.2％(49/80),高于成人组的40.2％ (90/224) (P＜0.05).肺炎链球菌对红霉素和克林霉素的耐药率分别为93.6％(292/312)和86.2％(269/312).各群β-溶血链球菌对青霉素均敏感,但对红霉素、克林霉素、四环素的耐药率均超过60％.发现4株万古霉素耐药肠球菌(VRE).粪肠球菌和屎肠球菌均对达托霉素和替加环素敏感,对利奈唑胺的敏感率分别为96.9％(157/162)和99.3％(150/151),对高浓度庆大霉素的耐药率分别为51.9％(84/162)和61.6％(93/151),粪肠球菌对氯霉素和四环素的敏感率低于屎肠球菌,但对其他所测试抗菌药物均有较高的敏感率.结论 不同地区、不同年龄组间革兰阳性球菌的耐药率有所差异；替考拉宁、万古霉素、利奈唑胺、替加环素和达托霉素对革兰阳性球菌具有很好的抗菌活性.
目的 調查2012年我國16傢醫院革蘭暘性毬菌臨床分離株的耐藥率.方法 收集2012年6至12月16傢教學醫院臨床分離的1790株非重複革蘭暘性毬菌.採用瓊脂稀釋法測定抗菌藥物的MIC,迴顧性研究不同病原菌對臨床常用抗菌藥物的耐藥率,採用一般x2檢驗比較不同年齡組中耐甲氧西林金黃色葡萄毬菌(MRSA)和耐青黴素肺炎鏈毬菌(PRSP)的髮生率.結果 MRSA和耐甲氧西林凝固酶陰性葡萄毬菌(MRCoNS)的髮生率分彆為43.6％ (264/605)和75.7％ (227/300),不同地區MRSA髮生率為20.5％ ～ 60.9％,不同標本中MRSA髮生率為:呼吸道標本54.4％(106/195)、血液標本43.6％(58/133)、傷口組織及膿液標本29.8％(56/188),老年組中MRSA髮生率(53.9％,110/204)高于成人組(41.4％,149/360)(P＜0.05).MRSA對氯黴素和複方新諾明的敏感率分彆為92.4％(244/264)和89.8％(237/264),對慶大黴素、紅黴素、剋林黴素、四環素、利福平和喹諾酮類藥物的敏感率為12.5％～51.9％,髮現1株對萬古黴素中介的金黃色葡萄毬菌(VISA),萬古黴素MIC值為3μg/ml.未髮現對替攷拉寧、萬古黴素、利奈唑胺和達託黴素耐藥的金黃色葡萄毬菌.PRSP在幼兒組中的髮生率為61.2％(49/80),高于成人組的40.2％ (90/224) (P＜0.05).肺炎鏈毬菌對紅黴素和剋林黴素的耐藥率分彆為93.6％(292/312)和86.2％(269/312).各群β-溶血鏈毬菌對青黴素均敏感,但對紅黴素、剋林黴素、四環素的耐藥率均超過60％.髮現4株萬古黴素耐藥腸毬菌(VRE).糞腸毬菌和屎腸毬菌均對達託黴素和替加環素敏感,對利奈唑胺的敏感率分彆為96.9％(157/162)和99.3％(150/151),對高濃度慶大黴素的耐藥率分彆為51.9％(84/162)和61.6％(93/151),糞腸毬菌對氯黴素和四環素的敏感率低于屎腸毬菌,但對其他所測試抗菌藥物均有較高的敏感率.結論 不同地區、不同年齡組間革蘭暘性毬菌的耐藥率有所差異；替攷拉寧、萬古黴素、利奈唑胺、替加環素和達託黴素對革蘭暘性毬菌具有很好的抗菌活性.
목적 조사2012년아국16가의원혁란양성구균림상분리주적내약솔.방법 수집2012년6지12월16가교학의원림상분리적1790주비중복혁란양성구균.채용경지희석법측정항균약물적MIC,회고성연구불동병원균대림상상용항균약물적내약솔,채용일반x2검험비교불동년령조중내갑양서림금황색포도구균(MRSA)화내청매소폐염련구균(PRSP)적발생솔.결과 MRSA화내갑양서림응고매음성포도구균(MRCoNS)적발생솔분별위43.6％ (264/605)화75.7％ (227/300),불동지구MRSA발생솔위20.5％ ～ 60.9％,불동표본중MRSA발생솔위:호흡도표본54.4％(106/195)、혈액표본43.6％(58/133)、상구조직급농액표본29.8％(56/188),노년조중MRSA발생솔(53.9％,110/204)고우성인조(41.4％,149/360)(P＜0.05).MRSA대록매소화복방신낙명적민감솔분별위92.4％(244/264)화89.8％(237/264),대경대매소、홍매소、극림매소、사배소、리복평화규낙동류약물적민감솔위12.5％～51.9％,발현1주대만고매소중개적금황색포도구균(VISA),만고매소MIC치위3μg/ml.미발현대체고랍저、만고매소、리내서알화체탁매소내약적금황색포도구균.PRSP재유인조중적발생솔위61.2％(49/80),고우성인조적40.2％ (90/224) (P＜0.05).폐염련구균대홍매소화극림매소적내약솔분별위93.6％(292/312)화86.2％(269/312).각군β-용혈련구균대청매소균민감,단대홍매소、극림매소、사배소적내약솔균초과60％.발현4주만고매소내약장구균(VRE).분장구균화시장구균균대체탁매소화체가배소민감,대리내서알적민감솔분별위96.9％(157/162)화99.3％(150/151),대고농도경대매소적내약솔분별위51.9％(84/162)화61.6％(93/151),분장구균대록매소화사배소적민감솔저우시장구균,단대기타소측시항균약물균유교고적민감솔.결론 불동지구、불동년령조간혁란양성구균적내약솔유소차이；체고랍저、만고매소、리내서알、체가배소화체탁매소대혁란양성구균구유흔호적항균활성.
Objective To investigate antimicrobial resistance among gram-positive cocci strains in China in 2012.Methods From June 2012 to December 2012,1790 consecutive and non-repetitive grampositive cocci strains were collected from 16 teaching hospitals.The minimal inhibitory concentrations (MICs) of antibacterial drugs were determined by agar dilution method.A retrospective study was conducted on the rates of resistance to antimicrobial agents.Data was analyzed using chi-square test.Results The prevalence of methicillin-resistant Staphylococcus aureus(MRSA) and methicillin-resistant coagulase-negative Staphylococci (MRCoNS) were 43.6％ (264/605) and 75.7％ (227/300),respectively.The prevalence of MRSA ranged from 20.5％ to 60.9％ in different regions.About 54.4％ (106/195) of Staphylococcus aureus from respiratory tract specimens,43.6％ (58/133) of Staphylococcus aureus from blood samples,and 29.8％ (56/188) of Staphylococcus aureus from wound and pus were resistant to methicillin.The prevalence of MRSA in elder patient group (53.9％,110/204) was higher than that in the younger adult patients (41.4％,149/360) (P＜0.05).The susceptible rates of MRSA to chloramphenicol and SXT were 92.4％(244/264) and 89.8％ (237/264),respectively.Susceptibility of MRSA to gentamycin,erythromycin,clindamycin,tetracyclines,rifampicin and quinolones were ranged from 12.5％ to 51.9％.One vancomycin-intermediate Staphylococcus aureus (VISA) was found in this study.All Staphylococci isolates were susceptible to teicoplanin,vancomycin,linezolid,daptomycin and tigecycline.The prevalence of penicillin-resistant Streptococcus pneumoniae (PRSP) in children below 3 years-old (61.2％,49/80) was higher than that in adult patients (40.2％,90/224) (P＜0.05).About 93.6％ (292/312) and 86.2％ (269/312) of S.pneumonia were resistant to erythromycin and clindamycin,respectively.Penicillin still showed a very high activity against Streptococcus spp.β-Hemolytic group,but more than 60％ of Streptococcus spp.β-hemolytic group were resistant to erythromycin,clindamycin and tetracyclines.Four vancomycin-resistant enterococcus (VRE) strains were found in this study.All Enterococcus isolates were susceptible to daptomycin and tigecycline,and 96.9％ (157/162) of E.faecalis and 99.3％ (150/151) of E.faecium were susceptible to line()dd.About 51.9％ (84/162) of E.faecalis and 61.6％ (93/151) of E.faecium were resistant to high concentration gentamycin.The susceptibility of E.faecalis to all antibiotics except chleramphenicol and tetracycline was higher than that of E.faecium.Conclusion The rates of antimicrobial resistance of Gram-positive cocci are different among strains isolated from different age groups or regions.Teicoplanin,vancomycin,linezolid,tigecycline and daptomycin showed very high activity against Gram-positive cocci.
