协和医学杂志

2014, v.5(04) 422-428

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2013年北京协和医院细菌耐药性监测
Surveillance of Antimicrobial Resistance in Peking Union Medical College Hospital 2013

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

摘要(Abstract):

目的了解北京协和医院2013年临床分离细菌对抗菌药物的耐药性。方法收集2013年1月1日至12月31日北京协和医院临床分离的7236株非重复细菌,采用纸片扩散法或自动化仪器法进行药敏试验,按美国临床实验室标准化协会2013年版标准判读药敏结果,采用WHONET 5.6软件进行数据分析。结果 7236株非重复的细菌中,革兰阴性菌占71.1%(5147株),革兰阳性菌占28.9%(2089株)。耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphalococcus aureus,MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus,MRCNS)的检出率分别为34.9%(244/700)和67.2%(123/183)。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。发现少数万古霉素和替考拉宁耐药的屎肠球菌,未发现对利奈唑胺耐药的肠球菌。产超广谱β-内酰胺酶(extended spectrumβ-lactamases,ESBLs)的大肠埃希菌、克雷伯菌属细菌(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌的检出率分别为49.5%(698/1410)、25.4%(235/925)和22.6%(30/133)。肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感,总耐药率1.5%~2.3%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为19.4%和15.6%。鲍曼不动杆菌对上述两种抗菌药物的耐药率分别为70.9%和72.0%。泛耐药鲍曼不动杆菌的检出率为42.9%(306/714)。结论细菌耐药性仍是临床重要问题,特别是泛耐药鲍曼不动杆菌,应采取有效的医院感染控制措施和合理使用抗菌药物。
Objective To investigate the antimicrobial resistance of bacteria isolated from clinical samples in Peking Union Medical College Hospital in 2013. Methods A total of 7236 nonduplicate clinical isolates were collected from January 1 to December 31,2013. Disk diffusion test( Kirby-Bauer method) and automated systems were employed to test the antimicrobial resistance of these isolates. The data were analyzed using WHONET5. 6 software and judged according to the Clinical and Laboratory Standards Institute guideline 2013. Results Of the 7236 nonduplicate clinical isolates,Gram-negative and Gram-positive bacteria accounted for 71. 1%( 5147)and 28. 9%( 2089),respectively. Methicillin-resistant Staphalococcus aureus( MRSA) accounted for 34. 9%( 244/700) and methicillin-resistant coagulase-negative Staphylococcus( MRCNS) accounted for 67. 2%( 123/183) of Staphalococcus aureus isolates. No staphylococcus strains resistant to vancomycin,teicoplanin,or linezol-id were detected. A few strains of Enterococcus faecium were found resistant to vancomycin and teicoplanin. No linezolid-resistant enterococcus strains were found. Extended spectrum β-lactamases( ESBLs)-producing strains accounted for 49. 5%( 698 /1410),25. 4%( 235 /925) and 22. 6%( 30 /133) in Escherichia coli,Klebsiella species( K. pneumoniae and K. oxytoca) and Proteus mirabilis,respectively. The Enterobacteriaceae strains were still highly sensitive to carbapenems,with only 1. 5%- 2. 3% resistant to carbapenems. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 19. 4% and 15. 6%,respectively. The resistance rates of Acinetobacter baumannii to these two antimicrobials were 70. 9% and 72. 0%,respectively. The prevalence of pan-resistant strains in Acinetobacter baumannii was 42. 9%( 306 /714). Conclusions Antimicrobial resistance is still a serious problem,especially pan-resistant Acinetobacter baumannii strains. It is mandatory to take effective measures controlling nosocomial infection and ensuring rational antimicrobial use.

关键词(KeyWords): 细菌耐药性监测;抗菌药;泛耐药菌;药敏试验
antimicrobial resistance surveillance;antimicrobial agents;pan-resistant bacteria;antimicrobial susceptibility test

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

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