2011年中国13家教学医院院内感染常见病原菌耐药性分析

陈宏斌，赵春江，王辉等.家教学医院院内感染常见病原菌耐药性分析.[J].中华内科杂志,2013,52(13):203-212

交叉感染; 细菌耐药监测; 多重耐药菌

　　陈宏斌 赵春江 王辉 曹彬 徐修礼 褚云卓 胡志东 卓超 胡必杰刘文恩 廖康 张嵘 曾吉 王勇

　100044北京大学人民医院检验科(陈宏斌、赵春江、王辉、王占伟);首都医科大学附属北京朝阳医院感

2013年

203-212

知网,万方

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(Bm)、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(M℃ ),数据输人WHoNET~s6软件进行耐药性分析。结果 ⒛11年1-12月收集各医院分离细菌共2100株,其中革兰阳性菌鲳8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%,⒉ V784)、肺炎克雷伯菌(14.8%,116/’ M)和金黄色葡萄球菌(10.6%,83刀斛);引起HAP的前3位病原菌依次是鲍曼不动杆菌(24,2%,15V652)、铜绿假单胞菌(23.0%,15O/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%,” 9/667)、屎肠球菌(13.3%,⒆ /6臼)和肺炎克雷伯菌(9.6%,“ /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“ 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B⒏ 和IAIc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、肺炎克霄伯菌中产超广谱β-内酰胺酶(Emh)菌株的发生率分别为“ 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%~I00%)、亚胺培南(87.5%~100%)(除摩根摩根菌夕卜)、阿米杼星(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%~IOO%)。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∞ 2%和” 2%,鲍曼不动杆菌对两者的敏感率分别为刀7%和 59%。对鲍曼不动杆菌敏感率较高的抗生素为多黏菌素B(1O0%)、替加环素(79.8%)、米诺环素 (~h^O4%)。B⒏ 中铜绿假单胞菌对常用抗菌药物的敏感率高于HAP和⒕I。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⒇%以上。洋葱伯克霍尔德菌对复方磺胺甲嗯唑、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 investigdte the pathogen profle of nt|socomia1infection in China,and tosu1η `ey the susceptibihty ratcs of these pathogens to the chnical common antibiotics ˇΙethods The non- ∞petitlve nosocomhl pathogens isolated from blood乩rcam infect0n(BsI), hospital acquircd pncumollla (HAP)and intra-abdominal ilfcction(IAI)and llae case data wclc colleded flom13tcaching hospilals in different areas of China and sent to a ccntral laboratO1of for re-idcntiflcation and susceptibility tcsting. Thc levels of minimal inhibitory conccntration(MIC)of thc common antibiotics were dctcrmined by agar山1ution method The data were ana1yzed by WHONET5 6software, Results A total of2103chnical isolatcs were collected frolll Janua叮 to Dccember 2011, of which gran1 positivc cocci and gram negative organisms accounted ftjr23.2% and76.8%　　ratcs of enteroCocczJs spccics to tigeCycline, teicoplanin and linczohd wcre al1 1009% The prevalence of extended-spel·tmm β -lactam灬es(ESBL)was643% in E coJj and383% in K Pneumonia Agalnst Enterobactcriaccac,thc most activc agents were as following in older:tigecydinc(92.3%100%)[except P,nirabilis],mσopenem(87.5%100%),imΦ cncm(87.5%100%)[exceptp.mirabilis ],amikacln (87.5%-100%),polymyxin B(75%-100%) [except s marces,p,mirabilis]cefepime(67.8%-100%),cef。perazone-slllbactam(66.6%-100%),"piperacillin-tazobactam(61.5%%,- 100%).Carbapenem-resistanct EnterclbacteΙ aceae stralns emerged.The susceptibility rates of P.aeruginosa to imipenem and meropcnem wcre66.2% and72.2%,respectlvely The susceptlbility rates of A. baumanii to imipem and meropenem 、tere 27.7% and 25 .99%, respectively The most active agents against A.baumanii Were po1ymyxin B(100%),fllowed by tigecydine(79,8%)and min。cyc1ine(50.4%) The susceptibi1ity rates of P . aeruginosa to antlbiotics in BSI 、vere higher than those in IIAP and IAI Susceptibihty rates of s .maltophilia to rnethoprim~sufamcthoxazole, minocychnc and lcvofloxacin were about 90%or above Susceptibility rates of B conclusions to trimethoprim-sulfamcthoxazo1e, ceftazidime and meropenem were all 100% severa1 P .aeruginosa and A.baumanii strains wcrc rcsistant to a11 tested antibiotics except po1ymyxin B Conclusions The pathogcn pro1i1c is different in diffcrcnt typcs of ilfcction Thc prevalcnce of multi-drug resistant A.baumanii is high, which is still a key problem of nosocomial illfection Tigecychne remains rclativcly high activity against gram-positive cocci and gramnegdllx e bacteⅡ a(except P.aeruginosa and p. mirabilis)in vitro.。