摘要
目的了解我国血流感染患者细菌的分布及耐药性,指导临床使用抗菌药物。方法采用纸片法、MIC法或E-test法测定细菌药物敏感性,使用WHONET5.6软件进行分析,对卫生部全国细菌耐药性监测网(Mohnarin)所属49所三级甲等医院2011年1月1日-12月31日分离的血及骨髓培养菌株进行分析。结果共分离细菌10 783株,包括革兰阳性菌5389株占50.0%、革兰阴性菌5374株占49.8%和厌氧菌20株占0.2%;其中凝固酶阴性葡萄球菌分离最多,共3098株占28.7%,其次为大肠埃希菌2066株、克雷伯菌属1018株、金黄色葡萄球菌828株和肠球菌属730株,分别占19.2%、9.4%、7.7%和6.8%;耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别为50.8%和67.4%,未发现耐万古霉素和利奈唑胺金黄色葡萄球菌;粪肠球菌和屎肠球菌中分别有0.5%和3.7%对万古霉素耐药,0.6%和3.1%对替考拉宁耐药;监测到利奈唑胺耐药的粪肠球菌1株及屎肠球菌7株;大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率分别为69.0%和48.0%,耐碳青霉烯类抗菌药物的主要肠杆菌科细菌明显增加;成人葡萄球菌属对喹诺酮类药物的耐药率明显高于儿童。结论我国血流及骨髓感染细菌以葡萄球菌属、大肠埃希菌和克雷伯菌属最多见;血、骨髓培养大肠埃希菌和肺炎克雷伯菌ESBLs的阳性率高,肠杆菌科细菌对碳青霉烯类抗菌药物耐药率增加。
OBJECTIVE To approach the distribution and drug resistance of the bacteria causing bloodstream infections in China so as to guide the clinical use of antibiotics.METHODS Disc diffusion test,MIC test and E-test were used to detect the antimicrobial sensitivity of bacterial isolates from blood and bone marrow cultures.WHONET 5.6 was applied for analyzing the bacterial sensitive data from 49 tertiary Mohnarin member hospitals in China from Jan 1 to Dec 31 2011.RESULTS A total of 10 783 strains were isolated,including 5389 strains of gram-positive bacteria（50.0%）,5374 strains of gram-negative bacteria（49.8%） and 20 strains of anaerobes of（0.2%）.Coagulase-negative Staphylococci（3098 strains,28.7%）,Escherichia coli（2066 strains,19.2%）,Klebsiella spp（1018 strains,9.4%）,Staphylococcus aureus（828 strains,7.7%） and Enterococcus species（730 strains,6.8%） were the most common species of isolates.The detection rates of the methicillin-resistant S.aureus and coagulase-negative Staphylococci were 50.8% and 67.4%,respectively.Vancomycin-and linezolid-resistant S.aureus and CNS strains were not detected.The resistance rates of Enterococcus faecalium and E.faecium to vancomycin were 0.5% and 3.7%,while to teicoplanin were 0.6% and 3.1%,respectively.One strain of E.faecalium and 7 strains of E.faecium resistant to linezolid were detected.The positive rates of ESBLs-producing E.coli and K.pneumoniae were 69.0% and 48.0%,respectively.Carbapenems-resistant Enterobacteriaceae kept an upward trend.The resistance rates of Staphylococcus spp isolated from the adults to quinolones were significantly higher than those from children.CONCLUSION Staphylococcus,E.coli and Klebsiella are the predominant pathogens in bloodstream infection in China.The positive rates of ESBLs-producing E.coli and K.pneumoniae cultured from blood and bone marrow are high,and the drug resistance of Enterobacteriaceae to carbapenems antibiotics keeps an upward trend.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2012年第24期5497-5502,5502,共6页
Chinese Journal of Nosocomiology
基金
卫生行业科研专项项目(201002021)
作者简介
通讯作者：肖永红，E-mail：xiao-yonghong@163．com
通讯作者：李兰娟，E-mail：ljli@zju．edu．cn
