2011—2012年安徽省立儿童医院细菌耐药性监测

Surveillance of antimicrobial resistance in Anhui Provincial Children’s Hospital during 2011-2012

摘要:

目的了解2011—2012年安徽省立儿童医院临床分离病原菌对常用抗菌药物的耐药性。方法采用KB纸片扩散法对该院临床分离的病原菌进行药敏试验。结果共检出病原体3 946株，革兰阳性菌、革兰阴性菌、真菌、支原体各占43.92%、37.91%、15.91%、2.26%。居病原体首位的为大肠埃希菌（16.32%），其次为肺炎链球菌（16.02%）、金黄色葡萄球菌（9.00%）、肺炎克雷伯菌（7.40%）等。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（MRCNS）分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的41.41%（147/355）、81.40%（197/242）；大肠埃希菌、肺炎克雷伯菌产超广谱β内酰胺酶（ESBLs）率分别为68.17％（439/644）、72.95％（213/292）。肺炎链球菌对红霉素（99.84%）、克林霉素（98.58%）高度耐药；MRSA对克林霉素、红霉素的耐药率较高（＞75%），MRSA和MRCNS对万古霉素、替考拉宁和利奈唑胺敏感率均为100.00%；屎肠球菌对万古霉素耐药率为98.31%；鲍曼不动杆菌除对头孢哌酮/舒巴坦耐药率（8.70%）较低，对其他抗菌药物耐药率均较高；铜绿假单胞菌耐药率较低的抗菌药物有亚胺培南、美罗培南、头孢他啶、阿米卡星和环丙沙星（＜26%）。检出4株对碳青霉烯类药物耐药的产ESBLs肺炎克雷伯菌，15 株泛耐药鲍曼不动杆菌。结论定期进行细菌耐药性监测，有助于了解医院细菌耐药变迁，为临床经验用药提供依据。

Abstract:

ObjectiveTo investigate the resistance of clinical bacterial isolates to commonly used antimicrobial agents in a hospital during 2011-2012.MethodsAntimicrobial susceptibility testing of clinically isolated pathogens was performed by KirbyBauer method.ResultsA total of 3 946 pathogenic isolates were detected, grampositive bacteria, gramnegative bacteria, fungi and mycoplasma accounted for 43.92%, 37.91%, 15.91%, and 2.26% respectively.The top one isolate was Escherichia coli (16.32%), followed by Streptococcus pneumoniae (16.02%), Staphylococcus aureus (9.00%), and Klebsiella pneumoniae （7.40%） and so on. Methicillinresistant Staphylococcus aureus (MRSA) and methicillinresistant coagulasenegative staphylococcus (MRCNS) respectively accounted for 41.41%（147/355）of Staphylococcus aureus and 81.40%（197/242）of coagulasenegative staphylococcus；extendedspectrum βlactamaseproducing rate of Escherichia coli and Klebsiella pneumoniae was 68.17%(439/644) and 72.95%（213/292）respectively. The resistant rate of Streptococcus pneumoniae to erythromycin and clindamycin was 99.84% and 98.58% respectively； the resistance rate of MRSA to clindamycin and erythromycin was higher (>75%),the resistance rates of MRSA and MRCNS to vancomycin, teicoplanin and linezolid were all 100.00%；the resistance rate of Enterococcus faecium to vancomycin was 98.31%；the resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam was low(8.70%), while to the other antimicrobial agents were all high； the resistance rate of Pseudomonas aeruginosa to imipenem, meropenem, ceftazidime,amikacin and ciprofloxacin were all low (<26%). Four carbapenemresistant ESBLproducing Klebsiella pneumoniae isolates and 15 pandrugresistant Acinetobacter baumannii were detected.ConclusionRegular monitor on drug resistance of bacteria helps to understand the changes in bacterial resistance in hospitals, and provide the basis for empirical antimicrobial use.