摘要
目的调查中国医院内感染的病原菌分布及其常见细菌对抗菌药物的敏感性。方法收集全国13家教学医院血流感染（BSI）、院内获得性肺炎（HAP）和院内获得性腹腔感染（IAI）患者标本的非重复病原菌及患者病例资料。菌株经中心实验室复核后，采用琼脂稀释法测定常用抗菌药物的最小抑菌浓度（MIC），数据输入WHONET5．6软件进行耐药性分析。结果2011年1-12月收集各医院分离细菌共2103株，其中革兰阳性菌488株（23．2％），革兰阴性菌1615株（76．8％）。致BSI的前3位病原菌依次是大肠埃希菌（31．0％，243／784）、肺炎克雷伯菌（14．8％，116／784）和金黄色葡萄球菌（10．6％，83／784）；引起HAP的前3位病原菌依次是鲍曼不动杆菌（24．2％，158／652）、铜绿假单胞菌（23．0％，150／652）和肺炎克雷伯菌（16．4％，107／652）；引起IAI的前3位病原菌依次为大肠埃希菌（34．3％，229／667）、屎肠球菌（13．3％，89／667）和肺炎克雷伯菌（9．6％，64／667）。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株的发生率分别为64．4％和78．1％。替加环素、万古霉素、替考拉宁和利奈唑胺对葡萄球菌属细菌保持100％敏感率。HAP中甲氧西林耐药的金黄色葡萄球菌（MRSA）的发生率显著高于BSI和IAI。替加环素、替考拉宁、利奈唑胺对粪肠球菌和屎肠球菌保持100％的敏感性。大肠埃希菌、肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）菌株的发生率分别为64．3％、38．3％。对肠杆菌科细菌而言，敏感率较高的抗生素依次为替加环素（92．3％-100％）（除奇异变形杆菌外）、美罗培南（87．5％-100％）、亚胺培南（87．5％-100％）（除摩根摩根菌外）、阿米卡星（87．5％-100％）、多黏菌素B（75％-100％）（除黏质沙雷菌、奇异变形杆菌和摩根摩根菌外）、头孢吡肟（67．8％-100％）、头孢哌酮-舒巴坦（66．6％-100％）、哌拉西林-他唑巴坦（61．5％-100％）。肠杆菌科细菌中已经出现了少数对碳青霉烯类耐药的菌株。铜绿假单胞菌对亚胺培南、美罗培南的敏感率分别为66．2％和72．2％，鲍曼不动杆菌对两者的敏感率分别为27．7％和25．9％。对鲍曼不动杆菌敏感率较高的抗生素为多黏菌素B（100％）、替加环素（79．8％）、米诺环素（50．4％）。BSI中铜绿假单胞菌对常用抗菌药物的敏感率高于HAP和IAI。嗜麦芽窄食单胞菌对复方磺胺甲嗯唑、米诺环素和左氧氟沙星的敏感率均在90％以上。洋葱伯克霍尔德菌对复方磺胺甲嚼唑、头孢他啶和美罗培南的敏感率均为100％。鲍曼不动杆菌和铜绿假单胞菌中均出现了对除多黏菌素B外所有测试抗生素均耐药的菌株。结论不同类型感染的病原谱不同；多重耐药鲍曼不动杆菌的发生率高，依然是困扰院内感染的重要问题之一；体外研究初步显示，替加环素对院内感染分离的革兰阳性和阴性菌（除铜绿假单胞菌和奇异变形杆菌外）有较好的抗菌活性。
Objective To investigate the pathogen profile of nosocomial infection in China, and to survey the susceptibility rates of these pathogens to the clinical common antibiotics. Methods The non- repetitive nosocomial pathogens isolated from bloodstream infection （BS]）, hospital acquired pneumonia （HAP） and intra-abdominal infection （IAI） and the case data were collected from 13 teaching hospitals in different areas of China and sent to a central laboratory for re-identification and susceptibility testing. The levels of minimal inhibitory concentration （MIC） of the common antibiotics were determined by agar dilution method. The data were analyzed by WHONET 5.6 software. Results A total of 2103 clinical isolates were collected from January to December 2011, of which gram positive cocci and gram negative organisms accounted for 23.2% and 76. 8% respectively. The top three pathogens of BSI were E. coil （31.0%, 243/784）, K. pneumoniae （ 14. 8%, 116/784） and S. aureus （ 10.6%, 83/784）. The top three pathogens of HAP were A. baumanii （ 24. 2%, 158/652）, P. aeruginosa （ 23.0%, 150/652 ） and K. pneumoniae （ 16. 4%, 107/652 ）. The top three pathogens of IAI were E. coli （ 34. 3%, 229/667 ）, E.faecium （13.3%, 89/667） and K. pneumoniae （9. 6%, 64/667 ）. Methicillin-resistant S. aureus （MRSA） and coagulase negative Staphylococcus （MRCNS） accounted for 64.4% and 78. 1% respectively. The susceptibility rates of Staphyloccus species to tigecycline, vancomycin, teicoplanin and linezolid were all 100%. The prevalence of MRSA in HAP was significantly higher than that in BSI or IAI. The susceptibility rates of Enterococcus species to tigecycline, teicoplanin and linezolid were all 100%. The prevalence of extended-spectrum f3-1actamases （ESBL）was 64.3% in E. coli and 38. 3% in K. pneumonia. Against Enterobacteriaceae, the most active agents were as following in order： tigecycline （92. 3%-100% ） [ except P. mirabilis], meropenem （87.5%-100% ）, imipenem （87.5%-100% ） [ except M. morganii], amikacin （87. 5%-100% ）, polymyxin B （75%-100%） [ except S. marcescens, P. mirabilis and M morganii], cefepime （67.8%-100% ）, cefoperazone-sulbactam （66. 6%-100% ）, piperacillin- tazobactam （61.5%- 100% ）. Carbapenem-resistanct Enterobacteriaceae strains emerged. The susceptibility rates of P. aeruginosa to imipenem and meropenem were 66. 2% and 72. 2% , respectively. The susceptibility rates of A. baumanii to imipenem and meropenem were 27. 7% and 25.9%, respectively. The most active agents against A. baumanii were polymyxin B （ 100% ）, followed by tigecycline （ 79. 8% ） and minocycline （ 50. 4% ）. The susceptibility rates of P. aeruginosa to antibiotics in BSI were higher than those in HAP and IAI. Susceptibility rates of S. maltophilia to trimethoprim-sulfamethoxazole, minocycline and levofloxacin were about 90% or above. Susceptibility rates of B. cepacia to trimethoprim-sulfamethoxazole, ceftazidime and meropenem were all 100%. Several P. aeruginosa and A. baumanii strains were resistant to all tested antibiotics except polymyxin B. Conclusions The pathogen profile is different in different types of infection. The prevalence of multi-drug resistant A. baumanii is high, which is still a key problem of nosocomial infection. Tigecycline remains relatively high activity against gram-positive cocci and gram- negative bacteria （except P. aeruginosa and P. mirabilis） in vitro.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2013年第3期203-212,共10页
Chinese Journal of Internal Medicine
基金
北京自然科学基金（5122041）
关键词
交叉感染
细菌耐药监测
多重耐药菌
Cross infection
Bacterial resistance surveillance
Multi-drug resistant bacteria
