摘要
目的了解我国血流感染患者细菌的分布及耐药状况。方法采用纸片法、MIC法或E-test法测定细菌药物敏感性,使用WHONET5.4软件进行分析,对卫生部全国细菌耐药性监测网(Mohnarin)所属89所三级甲等医院2008年1月1日-12月31日分离的血及骨髓培养菌株进行分析。结果共分离病原菌10519株,包括革兰阳性菌5554株(52.8%)、革兰阴性菌4929株(46.9%)和其他36株(0.3%),分离最多的为凝固酶阴性葡萄球菌,共3215株(30.6%),其次为大肠埃希菌1849株(17.6%)、金黄色葡萄球菌958株(9.0%),克雷伯菌属931株(8.9%)和肠球菌属729株(6.9%);耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别为66.2%和83.5%,未发现耐万古霉素金黄色葡萄球菌和凝固酶阴性葡萄球菌;粪肠球菌和屎肠球菌中分别有3.5%和5.0%对万古霉素耐药,2.6%和5.8%对替考拉宁耐药;大肠埃希菌和肺炎克雷伯菌ESBLs的阳性率分别为38.6%和27.5%,对头孢他啶耐药率上升明显;成人葡萄球菌属对氨基糖苷类和喹诺酮类药物的耐药率明显高于儿童,但儿童大肠埃希菌对氨基糖苷类和喹诺酮类药物的耐药率呈上升趋势。结论我国血流及骨髓感染细菌以葡萄球菌属、大肠埃希菌和克雷伯菌属最多见;儿童血流及骨髓感染革兰阳性细菌所占比例高于成人;血骨髓培养MRSA、MRCNS发生率和大肠埃希菌对头孢菌素的耐药率明显;儿童分离细菌对喹诺酮类药物的耐药率逐年增高。
OBJECTIVE To determine the bacterial distribution and resistance of bloodstream infections in China.METHODS Disc diffusion test,MIC test and E-test were used to detect the antimicrobial sensitivity of bacterial isolates from blood and bone marrow cultures.WHONET 5.4 was applied for analyzing the bacterial sensitive data from 89 tertiary care Mohnarin member hospitals in China from Jan 1,2008 to Dec 31,2008.RESULTS A total of 10 519 strains were isolated,including 5554 Gram-positive strains （52.8%）,4929 Gram-negative strains （46.9%） and 36 other strains （0.3%）.Coagulase-negative staphylococci （3215 strains,30.6%）,Escherichia coli （1849 strains,17.6%）,Staphylococcus aureus （958 strains,9.0%）,Klebsiella species （931 strains,8.9%） and Enterococcus species（729 strains,6.9%） were the most common isolates.The detected rates of the meticillin-resistant S.aureus and coagulase-negative staphylococci（CNS） were 66.2% and 83.5%,respectively.Vancomycin-resistant S.aureus and CNS strains were not detected.The resistant rates of Enterococcus faecalis and E.faecium to vancomycin were 3.5% and 5.0%,while to teicoplanin were 2.6% and 5.8%,respectively.The ESBLs positive rates of E.coli and K.pneumoniae were 38.6% and 27.5%,respectively.Ceftazidime-resistant rates increased obviously.The resistant rates of staphylococcus isolated from adults to aminoglycosides and quinolones were significantly higher than those from children,but the rate of E.coli isolated from children to aminoglycosides and quinolones kept an upward trend.CONCLUSION Staphylococcus,E.coli and Klebsiella are the predominant bacteria in bloodstream infection in China.The rate of Gram-positive bacteria from children with bloodstream and marrow infection was higher than that from adults.MRSA,MRCNS and E.coli from bloodstream and bone marrow culture are highly resistant to cephalosporin.The resistant rate of the bacteria isolated from children to quinolones increases year by year.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2010年第16期2399-2404,共6页
Chinese Journal of Nosocomiology
