摘要
目的了解2011年中国不同地区15所医院呼吸道病原菌的分布及耐药性。方法 15所教学医院(13所综合性医院,2所儿童医院)按照统一方案进行细菌耐药性监测,药敏试验采用纸片扩散法(K-B法)、自动化仪器法及E试验法,按照美国CLSI 2011年版标准判读结果,用WHONET5.6软件统计分析呼吸道标本分离菌的分布及耐药性。结果 15所医院呼吸道标本共分离出27 127株细菌,其中革兰阴性菌占80.8%,革兰阳性菌占19.2%。常见细菌依次为鲍曼不动杆菌(17.1%)、铜绿假单胞菌(16.3%)、肺炎克雷伯菌(14.2%)、金葡菌(12.7%)、大肠埃希菌(7.5%)、嗜麦芽窄食单胞菌(6.0%)、阴沟肠杆菌(3.9%)、肺炎链球菌(3.7%)、流感嗜血杆菌(2.6%)、化脓链球菌(1.5%)。药敏试验结果显示,儿童分离株中肺炎链球菌青霉素不敏感株(PRSP、PISP)检出率分别为13.6%、14.4%,明显高于成人分离株(1.4%、4.9%),化脓链球菌对青霉素和头孢菌素类抗生素高度敏感,肺炎链球菌和化脓链球菌对红霉素、克林霉素耐药率>70.0%,对氟喹诺酮类、万古霉素、利奈唑胺仍保持较高敏感性。在流感嗜血杆菌儿童株与成人株中,β内酰胺酶检出率分别为16.8%、34.8%,对阿奇霉素、头孢呋辛、左氧氟沙星敏感率>90.0%。金葡菌中未检出万古霉素、替考拉宁、利奈唑胺耐药株,甲氧西林耐药金葡菌(MRSA)检出率为60.1%。肠杆菌科细菌对碳青霉烯类、阿米卡星、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦较敏感;ICU分离的肺炎克雷伯菌对亚胺培南耐药率为23.6%,大肠埃希菌和肺炎克雷伯菌ESBLs检出率分别为80.1%、52.0%。鲍曼不动杆菌对亚胺培南、美罗培南耐药率均>60.0%,铜绿假单胞菌对阿米卡星、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、头孢吡肟、头孢他啶、环丙沙星、庆大霉素耐药率均<25.0%。ICU分离菌耐药性高于非ICU菌株。结论呼吸道病原菌以革兰阴性杆菌为主,细菌耐药现象严重,临床应重视病原菌的监测并结合药敏试验结果合理使用抗菌药物。
Objective To investigate the distribution and antimicrobial resistance of respiratory common pathogens isolated from 15 hospitals in several regions of China during 201l. Methods Thirteen general hospitals and 2 children＇s hospitals were in- volved in this program. Antimicrobial susceptibility testing was carried out by means of Kirby-Bauer （K-B）, automatic microbi ological analysis systems and E-test according to a unified protocol. The data were analyzed by WHONET5.6 software accord- ing to CLSI 2011 breakpoint. Results A total of 27 127 nonduplicate isolates from respiratory tract were collected, of which gram negative bacillus accounted for 80.8 %, gram-positive cocci 19.2 %. The most common isolates from respiratory tract were A. baumannii （17.1%）, P. aeruginosa （16.3%）, K. pneumoniae （14.2%）, S. aureus （12.7%）, E. coli （7.5%）, S. malto- philia （6.0%）, E. cloacae （3.9%） , S. pneumoniae （3.7%）, H. influenzae （2.6%）, S. pyogenes （1.5%）. The prevalence of penicillin non susceptible strains PISP and PRSP was 13.6% and 14.4% respectively in the isolates from children, which were higher than the prevalence in the isolates from adults （1.4% and 4.9% respectively）. S. pyogenes strains were highly sensitive to penicillin and cephalosporins. The resistant rates of S. pneumoniae and S. pyogenes isolates to erythromycin and clindamycin were higher than 70.0%, but these strains were highly sensitive to fluoroquinolones, vancomycin and linezolid. The prevalence of β-1actamase in H. influenzae strains isolated from children and adults were 16.8% and 34.8%, respective- ly. More than 90.0% of H. influenzae isolates were still sensitive to azithromycin,cefuroxime and levofloxacin. Methicillin re- sistant strains in S. aureus （MRSA）accounted for 60.1%. No S. aureus strain was found resistant to vancomycin, teicoplanin or linezolid. Enterobacteriaceae strains were relatively susceptible to carbapenems, amikacin, cefoperazone-sulbactam and pip- eracillin-tazobactam. But 23.6% of the K. pneumoniae strains isolated from ICU were resistant to imipenem. The prevalence of ESBLs-producing strains was 80.1 % and 52, 0% in E. coli and K. pneumoniae, respectively. The over all resistant rates of A. baumannii to imipenem and meropenem were higher than 60.0%. The resistant rate of P. aeruginosa was lower than 25.0% to amikacin, pipercillin-tazobactam, cefoperazone-sulbactam, cefepime, ceftazidime, ciprofloxacin orgentamicin. The isolates from ICU showed higher resistance than non-ICU strains. Conclusions Gram-negative bacilli are still the most common patho- gens in respiratory tract infections. The situation of antibiotic resistance is serious for most bacterial apecies. More attention should be paid to the monitoring of pathogens and rational use of antimicrobial agents according to the results of susceptibility testing.
出处
《中国感染与化疗杂志》
CAS
北大核心
2013年第5期357-364,共8页
Chinese Journal of Infection and Chemotherapy
关键词
病原菌
呼吸道感染
耐药性监测
pathogen
respiratory tract infectionl resistance surveillance
