张小江;杨启文;孙宏莉;王贺;王瑶;谢秀丽;窦红涛;宋红梅;朱任媛;陈雨;徐英春;
ZHANG Xiao-jiang,YANG Qi-wen,SUN Hong-li,WANG He,WANG Yao,XIE Xiu-li,DOU Hong-tao,SONG Hong-mei,ZHU Ren-yuan,CHEN Yu,XU Ying-chun Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

• 1:中国医学科学院 北京协和医学院 北京协和医院检验科

摘要(Abstract)：

目的了解重症监护病房病原菌分布及其耐药情况。方法 2008年1月至2011年12月间北京协和医院重症监护病房患者中连续分离到3507株非重复细菌,采用纸片扩散法对临床分离菌株进行药敏试验,按美国临床实验室标准化研究所2011年标准判读药敏结果 ,采用WHONET5.4软件分析数据。结果 3507株非重复细菌中,革兰阴性菌占74.7%,革兰阳性菌占25.3%。10种最常见的细菌分别为:鲍曼不动杆菌(28.1%)、铜绿假单胞菌(12.8%)、金黄色葡萄球菌(10.0%)、大肠埃希菌(7.8%)、肺炎克雷伯菌(7.7%)、凝固酶阴性葡萄球菌(7.1%)、嗜麦芽窄食单胞菌(5.2%)、屎肠球菌(4.4%)、阴沟肠杆菌(2.3%)、粪肠球菌(2.3%)。4年中耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative staphylococci,MRCNS)的总检出率分别为74.9%(262/350)和83.4%(206/247),MRSA中有82.6%的菌株对磺胺甲噁唑-甲氧苄啶敏感,MRCNS中有79.6%的菌株对利福平敏感。均未发现对万古霉素、替考拉宁和利奈唑胺耐药的菌株。粪肠球菌对氨苄西林(18.2%)、呋喃妥因(5.6%)和磷霉素(2.7%)的耐药率较低,屎肠球菌对万古霉素和替考拉宁的耐药率分别为9.5%和7.5%,粪肠球菌对二者的耐药率分别为1.3%和1.3%。产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的总检出率分别为60.2%(165/274)和46.8%(126/269)。鲍曼不动杆菌泛耐药株(除外米诺环素)的总检出率为60.4%(596/987),铜绿假单胞菌泛耐药株的总检出率为5.6%(25/450)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为82.8%和83.8%,对米诺环素的敏感率为58.0%。铜绿假单胞菌对阿米卡星的耐药率最低,为16.8%,对亚胺培南和美罗培南的耐药率分别为42.6%和35.3%。结论在重症监护病房,碳青霉烯类抗生素对大肠埃希菌和肺炎克雷伯菌仍保持高活性,鲍曼不动杆菌耐药性呈增长趋势,特别是多重耐药和泛耐药菌株。
Objective To investigate the rates of resistance in bacteria obtained from intensive care units (ICU) in Peking Union Medical College Hospital.Methods A total of 3507 non-duplicate clinical isolates from ICU were collected from January 2008 to December 2011.Disc diffusion test (Kirby-Bauer method) was employed to study the antimicrobial resistance.The data were analyzed by WHONET 5.4 software according to Clinical and Laboratory Standards Institute (CLSI) 2011 breakpoints.Results Among these 3507 non-duplicate clinical isolates,gram-negative organisms and gram-positive cocci accounted for 74.7% and 25.3%,respectively.The 10 most common pathogens in ICU were A.baumannii (28.1%),P.aeruginosa (12.8%),S.aureus (10.0%),E.coli (7.8%),K.pneumoniae (7.7%),coagulase-negative staphylococci (7.1%),S.maltophilia (5.2%),E.faecium (4.4%),E.cloacae (2.3%),and E.faecalis (2.3%).Methicillin-resistant Staphylococcus aureus (MRSA) strains and coagulase-negative staphylococci (MRCNS) accounted for 74.9%(262/350) and 83.4%(206/247),respectively.However,82.6% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 79.6% of MRCNS strains were susceptible to rifampin.No staphylococcal strain was resistant to vancomycin,teicoplanin,or linezolid.The resistance rates of faecalis to ampicillin (18.2%),nitrofurantoin (5.6%),and fosfomycin (2.7%) were low.The resistant rates of E.faecium and E.faecalis to vancomycin were 9.5% and 1.3%,while to teicoplanin were 7.5% and 1.3%,respectively.Extended spectrum β-lactamases (ESBLs)-producing strains accounted for 60.2%(165/274) and 46.8%(126/269) in E.coli and K.pneumoniae,respectively.The rates of pan-resistant (except minocycline) A.baumannii and P.aeruginosa were 60.4%(596/987)and 5.6%(25/450).The resistance rates of A.baumannii to imipenem and meropenem were 82.8% and 83.8%,respectively.The susceptible rate to minocycline was 58.0%.The resistance rates of P.aeruginosa to imipenem and meropenem were 42.6% and 35.3%,respectively.P.aeruginosa isolates showed the lowest resistant rate (16.8%) to amikacin.Conclusion Carbapenems remain highly active against E.coli and K.pneumoniae.The antibiotic resistance of A.baumanii is increasing,especially those multidrug-resistant and pandrug-resistant strains.

关键词(KeyWords)： 重症监护病房;细菌耐药性监测;抗菌药物;泛耐药菌
intensive care unit;bacterial resistance surveillance;antibacterial agents;panresistant bacterium

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张小江;杨启文;孙宏莉;王贺;王瑶;谢秀丽;窦红涛;宋红梅;朱任媛;陈雨;徐英春;
ZHANG Xiao-jiang,YANG Qi-wen,SUN Hong-li,WANG He,WANG Yao,XIE Xiu-li,DOU Hong-tao,SONG Hong-mei,ZHU Ren-yuan,CHEN Yu,XU Ying-chun Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

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DOI:

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