摘要
目的了解我国门急诊患者分离菌对抗菌药物的耐药状况。方法采用纸片法、MIC法或E-test法测定病原菌药物敏感性,使用WHONET5.4软件进行数据分析,对卫生部全国细菌耐药性监测网(Mohnarin)所属84所三级甲等医院2006年6月1日-2007年5月31日门急诊来源的病原菌药物敏感性进行分析。结果共分离病原菌8815株,包括革兰阳性菌3270株(37.1%),革兰阴性菌5358株(60.8%)和真菌187株(2.1%);其中大肠埃希菌分离最多,共2276株(25.8%),其次为凝固酶阴性葡萄球菌(CNS)1404株(15.9%)、铜绿假单胞菌725株(8.2%)、金黄色葡萄球菌(SAU)689株(7.8%)和肠球菌属638株(7.2%);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)的检出率分别为36.8%和73.9%,低于同期整体病原菌耐药监测水平,未发现耐万古霉素金黄色葡萄球菌和耐万古霉素凝固酶阴性葡萄球菌;粪肠球菌和屎肠球菌中分别有1.3%和3.8%对万古霉素耐药,2.1%和3.2%对替考拉宁耐药;链球菌属主要对大环内酯类与克林霉素耐药,β-溶血性链球菌(-βSHA)与酿脓链球菌对左氧氟沙星耐药率>30.0%;嗜血菌属对氨苄西林耐药率>30.0%;大肠埃希菌和肺炎克雷伯菌ESBLs的阳性率分别为21.4%和11.0%,低于同期整体监测水平;铜绿假单胞菌对阿米卡星、亚胺培南、头孢他啶的耐药率<30.0%。结论我国门急诊来源病原菌以大肠埃希菌、CNS、铜绿假单胞菌和SAU多见;儿童以革兰阳性菌为主,成人则以革兰阴性菌为主;门急诊来源MRSA的发生率、大肠埃希菌和肺炎克雷伯菌ESBLs的阳性率均较同期整体水平偏低。
OBJECTIVE To determine the bacterial distribution and resistance in outpatients and emergency patients in China. METHODS Disc diffusion test, MIC test or E-test were used to detect the antimicrobial sensitivity of bacterial isolates from outpatients and emergency patients. WHONET 5.4 was applied for analysis of the bacterial sensitive data from 84 tertiary Mohnarin member hospitals at different area in China from June 1, 2006 to May 31, 2007. RESULTS A total of 8815 organisms were collected in the survey period, which included 3270 （37.1%） Gram-positive bacteria strains, 5358 （60. 8%） Gram-negative bacteria strains and 187 fungal strains （2. 7%）. Escherichiacoli （2276 strains, 25. 8%/%0）, coagulase-negative Staphylococcius （CNS, 1404 strains, 15. 9V0）, Pseudomonas aeruginosa （725 strains, 8. 20%）, Staphylococcus aureus （689 strains, 7. 8%） and Enterococcus （638 strains, 7.2%） were the most common isolates. 36.8% And 73.9% of S. aureus and CNS were meticillinresistant, respectively, the incidence was lower than that of the overall bacteria collection survey. No glycopeptides-resistant Staphylococcus was detected. The resistant rates of Enterococcus faecalis and Enterococcus faeciurn to vancomycin were 1. 3% and 3. 8%, while to teicoplanin were 2. 1% and 3. 2%, respectively. Streptococcus were mainly resistant to macrolides and clindamycin and the resistant rates of β-hemolytic streptococcus and Streptococcus pyogenes to levofloxacin were over 3 0 % the resistant rates of Haemophilus influenzae to ampicillin was over 30% The ESBLs positive rate of E. coli and K. pneumoniae were 21.4% and 11.0%, respectively, being lower than the results of overall bacteria collection survey. The resistant rates of P. aeruginosa to amikacin, imipenem and ceftazidime were lower 30%. CONCLUSIONS E. coli, CNS, P. aerugino- sa and S. aureus are the predominant pathogens isolated in outpatients and emergency patients in China; Gram- positive bacteria are the most common organism in children, while Gram-negative in adults. MRSA incidence, and ESBLs positive rates of E. coli and K. pneurnoniae are lower than the results of overall bacteria collection surveillance.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2008年第9期1233-1237,共5页
Chinese Journal of Nosocomiology
关键词
全国细菌耐药性监测网
门急诊
病原菌
耐药
监测
Mohnarin
Outpatients and emergency patients
Bacterial distribution
Resistance
Antibacterial agents
Surveillance
作者简介
通讯作者：肖永红，E—mail；xiaoyonghong@bjmu．edu．cn
