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目的了解2015年上海市细菌耐药性监测结果。方法采用纸片扩散法或自动化仪器法对上海市44所医院的临床分离菌进行药敏试验,包括27所三级医院(其中含3所儿童医院)和17所二级医院。采用美国临床和实验室标准化协会(CLSI)2015年版标准判断结果。结果 107 853株临床分离菌,革兰阳性菌31 585株,占29.3%;革兰阴性菌76 268株,占70.7%。MRSA和MRCNS的检出率分别占各自菌种的46.9%和74.2%。MRSA、MRCNS在二级医院和三级医院的平均检出率分别为53.6%、70.3%和44.3%、75.6%。葡萄球菌属中未发现万古霉素和利奈唑胺耐药株。1 021株肺炎链球菌儿童非脑膜炎分离株中青霉素敏感(PSSP)、中介(PISP)和耐药(PRSP)株的检出率分别为77.8%、13.3%和8.9%。232株成人分离株PSSP、PISP和PRSP分别为88.4%、5.2%和6.4%。检出51株屎肠球菌和3株粪肠球菌耐万古霉素。根据PCR测序,多数耐万古霉素肠球菌为vanA基因型。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中ESBL的检出率分别为57.0%、32.3%和41.5%。上述ESBL菌株在二级医院和三级医院的检出率分别为58.0%、29.0%、45.5%和56.5%、33.9%、40.2%。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,对亚胺培南和美罗培南的总耐药率分别为7.4%和7.7%。鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌中有少数菌株为广泛耐药株。结论细菌耐药性仍对临床构成严重威胁,需引起高度重视,避免耐药株的广泛传播。
Objective To understand the surveillance results of bacterial resistance in Shanghai in 2015. Methods Susceptibility testing of clinical isolates from 44 hospitals in Shanghai was conducted by disk diffusion method or automated instrumentation, including 27 tertiary hospitals (including 3 children’s hospitals) and 17 secondary hospitals. The results of the 2015 edition of CLSI (American Society of Clinical and Laboratory Standards Institute) were used. Results Of 107 853 clinical isolates, 31 585 were Gram-positive bacteria, accounting for 29.3%; 76 268 were gram-negative bacteria, accounting for 70.7%. The detection rates of MRSA and MRCNS accounted for 46.9% and 74.2% of the respective strains. The average detection rates of MRSA and MRCNS in secondary and tertiary hospitals were 53.6%, 70.3%, 44.3% and 75.6% respectively. Vancomycin and linezolid resistant strains were not found in Staphylococcus. The detection rates of penicillin-sensitive (PSSP), mediator (PISP) and drug-resistant (PRSP) strains in 1 021 S. pneumoniae non-meningitis isolates were 77.8%, 13.3% and 8.9%, respectively. 232 adult strains PSSP, PISP and PRSP were 88.4%, 5.2% and 6.4% respectively. 51 strains of Enterococcus faecium and 3 strains of Enterococcus faecalis were detected. According to PCR sequencing, most vancomycin-resistant enterococci were of the vanA genotype. The detection rates of ESBL in Escherichia coli, Klebsiella (Klebsiella pneumoniae and Klebsiella oxytoca) and Proteus mirabilis were 57.0%, 32.3% and 41.5%, respectively. The detection rates of the ESBL strains in secondary and tertiary hospitals were 58.0%, 29.0%, 45.5% and 56.5%, 33.9% and 40.2% respectively. Enterobacteriaceae are still highly susceptible to carbapenem antibiotics with a total resistance of 7.4% and 7.7% to imipenem and meropenem, respectively. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli in a few strains of widely resistant strains. Conclusions Bacterial drug resistance still poses a serious threat to clinical practice, which needs to be given high priority to avoid widespread transmission of drug-resistant strains.