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卫生部全国细菌耐药监测网(Mohnarin)2011-2012年革兰阴性菌耐药监测报告

Antimicrobial susceptibility surveillance of gram-negative bacterial from Mohnarin 2011-20112

【作者】 李耘吕媛薛峰张秀珍胡云建于庭胡志东赵建宏潘世扬胡必杰俞云松邓秋连李艳刘文恩周玲费樱府伟灵徐修礼裴凤艳孟灵季萍汤进郑波刘健杨维维张佳

【Author】 LI Yun;LV Yuan;XUE Feng;ZHANG Xiu-zhen;HU Yun-jian;YU Ting;HU Zhi-dong;ZHAO Jian-hong;PAN Shi-yang;HU Bi-jie;YU Yun-song;DENG Qiu-lian;LI Yan;LIU Wen-en;ZHOU Ling;FEI Ying;FU Wei-ling;XU Xiu-li;PEI Feng-yan;MENG Ling;JI Ping;TANG Jin;ZHENG Bo;LIU Jian;YANG Wei-wei;ZHANG Jia;Institute of Clinical Pharmacology,Peking University First Hospital;Beijing Hospital;Jilin University Second Hospital;Tianjin Medical University General Hospital;The Second Hospital of Hebei Medical University;The First Affiliated Hospital with Nanjing Medical University;Zhongshan Hospital Fudan University;Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University;Guangzhou Women and Children’s Medical Center;Renmin Hospital of Wuhan University;Xiangya Hospital Central-south University;Kunming First People’s Hospital;Affiliated Hospital of Guiyang Medical College;Southwest Hospital,Third Military Medical University;Xijing Hospital,Forth Military Medical University;Jinan Central Hospital Affiliated to Shandong University;Lanzhou University Second Hospital;The First Teaching Hospital of Xinjiang Medical University;Hanzhong Center Hospital;

【机构】 北京大学第一医院临床药理研究所北京医院吉林大学第二医院天津医科大学总医院河北医科大学第二医院南京医科大学第一附属医院复旦大学中山医院浙江大学邵逸夫医院广州市妇女儿童医疗中心武汉大学人民医院中南大学湘雅医院昆明市第一人民医院贵阳医学院附属医院第三军医大学西南医院第四军医大学西京医院济南市中心医院兰州大学第二医院新疆医科大学第一医院汉中市中心医院

【摘要】 目的监测我国主要城市三级甲等医院住院患者的细菌耐药状况。方法定点收集全国医院临床分离细菌,由中心实验室按美国临床实验室标准协会(CLSI)指南、统一用琼脂二倍稀释法,测定抗菌药物最低抑菌浓度(MIC)。结果对2011-07—2012-06来自全国18座城市18家医院的3893株临床分离革兰阴性菌进行了MIC测定。肠杆菌科细菌对碳青霉烯类抗生素仍保持很高的敏感性,敏感率大于96%;此外,替加环素、拉氧头孢、酶抑制剂复方制剂、阿米卡星及磷霉素等也具有很好抗菌活性,耐药率基本在10%以下。非发酵革兰阴性菌中,铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为29.0%和62.3%,多重耐药(MDR)菌检出率分别为39.4%和80.3%,广泛耐药(XDR)菌检出率分别为11.1%和72.5%。不同病房、不同年龄以及不同标本来源菌株耐药率比较显示,重症监护病房(ICU)菌株耐药率高于非ICU,其中鲍曼不动杆菌最为显著。来自儿童的铜绿假单胞菌和鲍曼不动杆菌耐药率显著低于成人和老年人(P<0.05)。不同标本来源菌株耐药率总体差异不大。结论鲍曼不动杆菌耐药率仍在增长。大肠埃希菌对多种抗菌药物的耐药率明显高于国外报道。碳青霉烯不敏感肠杆菌检出率虽不高,但有增加趋势。

【Abstract】 Objective To investigate the antibacterial resistance in nationwide and understand the distribution of bacterial and trend of antimicrobial resistance. Methods All the clinical isolates were collected from hospitals and the susceptibility tests were performed using agar dilution method recommended by Clinical and Laboratory Standards Institute( CLSI) in central laboratory. The susceptibilities of isolates to antimicrobial agents were determined by using CLSI( 2013) or European Committee on Antimicrobial Susceptibility Testing( EUCAST)( 2013) guideline. Results A total of 3893 gram- negative pathogenic isolates from 18 tertiary hospitals in 18 cities nationwide over the period from July 2011 to June 2012 were studied. Based on the MIC results,a vast majority of Enterobacteriaceae maintained high susceptibility to carbapenems,with susceptible rate more than 96%. In addition,tigecycline,moxalactam, compound preparation of β- lactamase inhibitor,amikacin and fosfomycin displayed desirable antibacterial activity against Enterbacteriaceae, and resistance rates to these drugs were all less than 10%. For non- fermenting Gram- negative isolates, resistance rate of P. aeruginosaand A. baumannii to imipenem were 29. 0% and 62. 3% and multidrug- resistant( MDR) detection rate were 39. 4% and 80. 3%,Extensively drug- resistant( XDR) were 11. 1% and 72. 5%,respectively. Resistance rates of strains isolated from Intensive Care Unit( ICU) were higher than those from non- ICU,especially A. baumannii,P. aeruginosa and A. baumannii isolated from children( ≤14 years) were more susceptible than those from other patients. Strains isolated from different specimens groups showed similar resistance rates. Conclusion Compared with surveillance results in the past,significant increase in resistance rates of A. baumannii were demonstrated. Many antimicrobial agents resistant rate for E. coli were higher than foreign countries. Gently growth of carbapenem non- susceptible Enterobacteriaceae should be paid more attention.

【关键词】 细菌耐药监测; 最低抑菌浓度; 敏感率; 耐药率;

【Key words】 antimicrobial resistance surveillance; minimum inhibitory concentration; susceptibility; resistance;

【分类号】R962;R378.84;R915;

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