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学科主题: 药理学
题名:
我国2009至2010年MOHNARIN项目临床分离常见病原菌的耐药监测
其他题名: Antimicrobial susceptibility surveillance in China: a MOHNARIN program report (2009-2010)
作者: 李耘1; 吕媛1; 薛峰1; 刘健1; 郑波1; 张秀珍1; 胡云建1; 于庭1; 褚云卓1; 胡志东1; 赵建宏1; 潘世扬1; 赵旺胜1; 胡必杰1; 邓秋连1; 杨健1; 李艳1; 刘文恩1; 周玲1; 董方1; 府伟灵1; 徐修礼1; 裴凤艳1; 孟灵1; 季萍1; 李曼宁1; 杨维维1; 张佳1
关键词: 抗药性,细菌 ; 微生物敏感性试验 ; 肠杆菌科 ; 葡萄球菌,金黄色 ; Drug resistance,bacterial ; Microbial sensitivity tests ; Enterobacteriaceae ; Staphyloccocus aureus
刊名: 中华检验医学杂志
发表日期: 2012
DOI: 10.3760/cma.j.issn.1009-9158.2012.01.016
卷: 35, 期:1, 页:67-87
收录类别: 中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型: Journal Article
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,了解临床分离病原菌分布及耐药趋势.方法 定点收集来自全国17座城市19家医院的6507株临床分离细菌,4691株分离白研究病房,1816株分离自研究病房以外.由中心实验室采用美国临床和实验室标准协会(Clinical and Laboratory Standards Institute,CLSI)推荐的琼脂二倍稀释法测定抗菌药物最低抑菌浓度值.采用统计软件SPSS 17.0计算MIC50、MIC90和MIC范围,并根据CLSI 2010颁布抗菌药物临界浓度标准进行耐药分析.结果 来自研究病房的4691株细菌中,革兰阳性菌1156株,占24.6%,革兰阴性菌3535株,占75.4%.最低抑菌浓度检测结果显示,甲氧西林耐药金黄色葡萄球菌和甲氧西林耐药表皮葡萄球菌检出率分别为51.6%(325/630)和87.0% (228/262),未发现对万古霉素中介或耐药的葡萄球菌.凝固酶阴性葡萄球菌对替考拉宁有2.5%( 16/642)的中介率和1.6%( 10/642)的耐药率,对利奈唑胺耐药率为0.5% (3/642).粪肠球菌对氨苄西林耐药率为17.1%(19/111),屎肠球菌则高达85.0% (164/193);发现3株对糖肽类耐药的屎肠球菌,耐药率1.5%(3/193).青霉素耐药肺炎链球菌和青霉素中介肺炎链球菌的检出率按口服青霉素标准判定分别为41.2%( 145/352)和37.2%(131/352);按静脉对非脑膜炎标准判定分别为0.0%( 0/352)和6.0%(21/352).肠杆菌科细菌对碳青霉烯类抗生素仍保持很高的敏感性,耐药率基本小于2.0%,此外,替加环素、拉氧头孢、磷霉素、阿米卡星也具有很好的抗菌活性,耐药率均在10.0%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23.1%(139/601)和53.5%(419/784),其中鲍曼不动杆菌耐药率较2007至2008年的监测结果有明显增加.多黏菌素、替加环素、米诺环素和磷霉素对鲍曼不动杆菌表现出较好的体外抗菌作用.结论 与以往的监测结果比较,除鲍曼不动杆菌耐药率增长较明显外,其他菌种(属)耐药状况稳定.利奈唑胺、替加环素等新抗菌药物中,也已发现耐药菌株.细菌耐药不容忽视,合理用药不容疏忽. Objective To investigate the bacterial resistance in nationwide and understand the distribution of bacterial and resistance trend.Methods The 6507 clinical isolates were collected from 19 hospitals in 17 cities.The susceptibility tests were performed using agar dilution method recommended by Clinical and Laboratory Standards Institute (CLSI) in central laboratory.The values of MIC50,MIC90 and MICrange were calculated by SPSS 17.0 and the susceptibilities of isolates to antimicrobial agents were determined by using CLSI (2010) guideline.Of all 6507 isolates,4691 strains were collected from target wards and 1816 were isolated from others wards.Results Among 4691 strains,1156 were Gram-positive (24.6% ) and 3535 were Gram-negative (75.4%).Based on the minimum inhibitory concentration results,the prevalence of methicillin resistant Stapylococcus aureus and methicillin resistant Stapylococcus epidermidis are 51.6% ( 325/630 ) and 87.0% ( 228/262 ) respectively.Staphylococci showing intermediate or full resistance to vancomycin were not observed. Coagulase negative Staphylococci showed 2.5% (16/642)intermediate rate and 1.6% ( 10/642 ) full resistance rate to teicoplanin,and showed 0.5% ( 3/642 )resistance rate to linezolid.Antibiotic resistance rate of Enterococcus faecalis to ampicillin was 17.1%(19/111),while the resistance rate of Enterococcus faecium to ampicillin reached up to 85.0%(164/193).Three Enterococcus faecium were resistant to glycopeptides.The prevalence of penicillin resistance Streptococcus pneumoniae and penicillin intermediate Streptococcus pneumoniae were 41.2% ( 145/352) and 37.2% (131/352) respectively based on oral penicillin criterion,while the prevalence were 0.0% (0/352) and 6.0% (21/352) based on vein to non-meningitis criterion.A vast majority of Enterobacteriaceae maintained high susceptibility to carbapenems,with resistance rate less than 2.0%.In addition,tigecycline,moxalactam,fosfomycin and amikacin displayed desirable antibacterial activity against Enterbacteriaceae,and resistance rates to these drugs were all less than 10.0%.For non-fermenting Gramnegative isolates,resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 23.1% ( 139/601 ) and 53.5% (419/784) respectively.Resistance rate of Acinetobacter baumannii was much higher than that during the period 2007 - 2008.Colistin,tigecycline,minocycline and fosfomycin demonstrated good antibacterial activity against Acinetobacter baumannii in vitro.Conclusions Compared with MOHNARIN 2007 -2008 year surveillance results, significant increase in resistance rate of Acinetobacter baumannii was demonstrated.Resistant strains to linezolid and tigecycline were found.Bacterial resistance has been a widespread problem in our country,which requires much more attention.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/44413
Appears in Collections:北京大学第一临床医学院_临床药理研究所_期刊论文

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作者单位: 1.100191,北京大学第一医院临床药理研究所
2.北京医院检验科
3.吉林大学第二医院检验科
4.中国医科大学第一医院检验科
5.天津医科大学总医院检验科
6.河北医科大学第二医院检验科
7.南京医科大学第一附属医院临检中心
8.复旦大学中山医院临床微生物室
9.广州市妇女儿童医疗中心检验科
10.深圳市人民医院呼吸科
11.武汉大学人民医院检验科
12.中南大学湘雅医院检验科
13.昆明市第一人民医院检验科
14.北京儿童医院检验科
15.第三军医大学西南医院检验科
16.第四军医大学西京医院检验科
17.济南市中心医院检验科
18.兰州大学第二医院检验科
19.新疆医科大学第一医院检验科

Recommended Citation:
李耘,吕媛,薛峰,等. 我国2009至2010年MOHNARIN项目临床分离常见病原菌的耐药监测[J]. 中华检验医学杂志,2012,35(1):67-87.
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