中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2012年
11期
1021-1028
,共8页
郭宇%王辉%赵春江%王占伟%张菲菲%曹彬%胡必杰%廖康%梅亚宁%杨青%徐英春%陈民钧%胡志东%孙自镛%张莉滟%俞云松%褚云卓%徐修礼%倪语星
郭宇%王輝%趙春江%王佔偉%張菲菲%曹彬%鬍必傑%廖康%梅亞寧%楊青%徐英春%陳民鈞%鬍誌東%孫自鏞%張莉滟%俞雲鬆%褚雲卓%徐脩禮%倪語星
곽우%왕휘%조춘강%왕점위%장비비%조빈%호필걸%료강%매아저%양청%서영춘%진민균%호지동%손자용%장리염%유운송%저운탁%서수례%예어성
革兰氏阳性球菌%抗药性,细菌%药物监测
革蘭氏暘性毬菌%抗藥性,細菌%藥物鑑測
혁란씨양성구균%항약성,세균%약물감측
Gram-positive cocci%Drug resistance,bacterial%Drug monitoring
目的 调查2011年我国14家医院革兰阳性球菌临床分离株的耐药率.方法 收集2011年6至12月14家教学医院临床分离的1498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,对不同病原菌对临床常用抗菌药物的耐药率做回顾性研究,采用一般x2检验比较不同年龄组中青霉素不敏感的肺炎链球菌(PNSSP)的发生率.结果 耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCoNS)发生率分别为43.7％(222/508)和85.6％(214/250)；不同地区MRSA发生率20.0％ ～63.5％,不同标本中MRSA发生率为:呼吸道标本58.2％(82/141),血液标本44.8％(48/107),脓及伤口标本23.8％(31/130).MRSA对氯霉素和复方磺胺甲噁唑的敏感率分别为94.1％(209/222)和83.3％ (185/222),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11.3％～52.3％,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；发现5株万古霉素耐药肠球菌(VRE)；粪肠球菌和屎肠球菌对达托霉素敏感率为100.0％(268/268),对利奈唑胺的敏感率分别为98.3％(118/120)和99.3％(147/148),对高浓度庆大霉素的耐药率分别为45.9％(68/148)和67.5％(81/120),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；PNSSP的比例为15.5％(37/239),≤3岁以下幼儿组PNSSP分离率为25％ (13/52),其他年龄组人群分离率为13％(24/187)；肺炎链球菌对红霉素、克林霉素、四环素的耐药率分别为91.6％(219/239)、88.7％(212/239)和88.3％(211/239),未发现对替考拉宁、万古霉素、利奈唑胺、替加环素和达托霉素耐药的肺炎链球菌；各组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％.结论 不同地区革兰阳性球菌的耐药率有所差异,较往年有增高趋势,应引起重视；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2011年我國14傢醫院革蘭暘性毬菌臨床分離株的耐藥率.方法 收集2011年6至12月14傢教學醫院臨床分離的1498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,對不同病原菌對臨床常用抗菌藥物的耐藥率做迴顧性研究,採用一般x2檢驗比較不同年齡組中青黴素不敏感的肺炎鏈毬菌(PNSSP)的髮生率.結果 耐甲氧西林金黃色葡萄毬菌(MRSA)和耐甲氧西林凝固酶陰性葡萄毬菌(MRCoNS)髮生率分彆為43.7％(222/508)和85.6％(214/250)；不同地區MRSA髮生率20.0％ ～63.5％,不同標本中MRSA髮生率為:呼吸道標本58.2％(82/141),血液標本44.8％(48/107),膿及傷口標本23.8％(31/130).MRSA對氯黴素和複方磺胺甲噁唑的敏感率分彆為94.1％(209/222)和83.3％ (185/222),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11.3％～52.3％,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；髮現5株萬古黴素耐藥腸毬菌(VRE)；糞腸毬菌和屎腸毬菌對達託黴素敏感率為100.0％(268/268),對利奈唑胺的敏感率分彆為98.3％(118/120)和99.3％(147/148),對高濃度慶大黴素的耐藥率分彆為45.9％(68/148)和67.5％(81/120),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；PNSSP的比例為15.5％(37/239),≤3歲以下幼兒組PNSSP分離率為25％ (13/52),其他年齡組人群分離率為13％(24/187)；肺炎鏈毬菌對紅黴素、剋林黴素、四環素的耐藥率分彆為91.6％(219/239)、88.7％(212/239)和88.3％(211/239),未髮現對替攷拉寧、萬古黴素、利奈唑胺、替加環素和達託黴素耐藥的肺炎鏈毬菌；各組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％.結論 不同地區革蘭暘性毬菌的耐藥率有所差異,較往年有增高趨勢,應引起重視；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 조사2011년아국14가의원혁란양성구균림상분리주적내약솔.방법 수집2011년6지12월14가교학의원림상분리적1498주비중복혁란양성구균.채용경지희석법측정항균약물적MIC,대불동병원균대림상상용항균약물적내약솔주회고성연구,채용일반x2검험비교불동년령조중청매소불민감적폐염련구균(PNSSP)적발생솔.결과 내갑양서림금황색포도구균(MRSA)화내갑양서림응고매음성포도구균(MRCoNS)발생솔분별위43.7％(222/508)화85.6％(214/250)；불동지구MRSA발생솔20.0％ ～63.5％,불동표본중MRSA발생솔위:호흡도표본58.2％(82/141),혈액표본44.8％(48/107),농급상구표본23.8％(31/130).MRSA대록매소화복방광알갑오서적민감솔분별위94.1％(209/222)화83.3％ (185/222),대경대매소、홍매소、극림매소、사배소、리복평화규낙동류약물적민감솔11.3％～52.3％,미발현대체고랍저、만고매소、리내서알화체탁매소내약적금황색포도구균；발현5주만고매소내약장구균(VRE)；분장구균화시장구균대체탁매소민감솔위100.0％(268/268),대리내서알적민감솔분별위98.3％(118/120)화99.3％(147/148),대고농도경대매소적내약솔분별위45.9％(68/148)화67.5％(81/120),분장구균대록매소화사배소적민감솔저우시장구균,단대기타소측시항균약물균유교고적민감솔；PNSSP적비례위15.5％(37/239),≤3세이하유인조PNSSP분리솔위25％ (13/52),기타년령조인군분리솔위13％(24/187)；폐염련구균대홍매소、극림매소、사배소적내약솔분별위91.6％(219/239)、88.7％(212/239)화88.3％(211/239),미발현대체고랍저、만고매소、리내서알、체가배소화체탁매소내약적폐염련구균；각조β용혈련구균대청매소균민감,단대홍매소、극림매소、사배소적내약솔균초과60％.결론 불동지구혁란양성구균적내약솔유소차이,교왕년유증고추세,응인기중시；체고랍저、만고매소、리내서알、체가배소화체탁매소대혁란양성구균구유흔호적항균활성.
Objective To investigate antimicrobial resistance among gram-positive cocci in 14 teaching hospitals in China in 2011.Methods From June 2011 to December 2011,1498 consecutive and non-repetitive gram-positive cocci were collected from 14 teaching hospitals.The minimal inhibitory concentration (MIC) of antibacterial agents was determined by agar dilution method.A retrospective study was conducted on rates of resistance to antimicrobial agents.Data was compared using chi-square test.Results The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillinresistant coagulase-negative Staphylococci (MRCoNS) was 43.7％ (222/508),and 85.6％ (214/250),respectively.The MRSA prevalence ranged from 20.0％ to 63.5％ in different regions.About 58.2％ (82/141) of Staphylococcus aureus from respiratory tract specimens,44.8％ (48/107) of Staphylococcus aureus from blood samples,and 23.8％ (31/130) of Staphylococcus aureus from pus and wound were resistant to methicillin.The susceptible rates of MRSA to chloramphenicol and sulfamethoxazole-trimethoprim SXT were 94.1％ (209/222) and 83.3％ (185/222),respectively.Susceptibility to gentamycin,erythromycin,clindamycin,tetracyclines,rifampicin and quinolones were from 11.3％ to 52.3％.All Staphylococci isolates were susceptible to vancomycin,teicoplanin,linezolid and daptomycin.Five vancomycin-resistant enterococcus (VRE) strains were found in this study.All enterococcus isolates were susceptible to daptomycin(268/268),and 98.3％ (118/120) of E.faecalis and 99.3％ (147/148) of E.faecium were susceptible to linezoild.About 45.9％ (68/148) of E.faecalis and 67.5％ (81/120) of E.faecium were resistant to high concentration gentamycin.The susceptibility of E.faecalis to all the antibiotics except for chloramphenicol and tetracycline was higher than that of E.faecium.The prevalence of penicillinnonsusceptible Streptococcus pneumoniae (PNSSP) was 15.5％ (37/239).The prevalence of PNSSP in children below 3 years-old was 25％ (13/52),and the prevalence of PNSSP from other patients was 13％(24/187).About 91.6％ (219/239),88.7％ (212/239) and 88.3％ (211/239) of S.pneumonia was resistant to erythromycin,clindamycin and tetracyclines.All S.pneumoniae strains were susceptible to teicoplanin,vancomycin,linezolid,tigecycline and daptomycin.Penicillin still showed high activity against Streptococcus spp.β-hemolytic group.More than 60％ of Streptococcus.spp.β-hemolytic group are resistant to erythromycin,clindamycin and tetracyclines.Conclusions Based on regions,the resistance rates of Gram-positive cocci are different,of which,the increasing tendency should be taken seriously.Teicoplanin,vancomycin,linezolid,tigecycline and daptomycin show very high activity against Gram-positive cocci.
