摘要
目的了解国内主要地区14所教学医院尿标本中的临床分离菌及其对常用抗菌药物的耐药性。方法采用K-B法按统一方案进行细菌药物敏感试验。按CLSI 2010版标准判断结果。结果 2010年1—12月各医院尿标本临床分离菌共9 301株;占临床分离菌株的19.4%(9 301/47 850)。其中革兰阳性菌2 403株,占25.8%,革兰阴性菌6 898株,占74.2%。以大肠埃希菌最为多见,占49.0%;其次为肠球菌属细菌占22.1%。约68%的菌株分离自住院患者,32%的菌株分离自门急诊患者;约64%的菌株分离自女性患者,36%的菌株分离自男性患者。大肠埃希菌、克雷伯菌属细菌(肺炎克雷伯菌+产酸克雷伯菌)以及奇异变形杆菌中的ESBLs的检出率(58.4%、59.8%和14.4%)与同期CHINET监测的检出率相仿。粪肠球菌和屎肠球菌中均有少数万古霉素耐药株,万古霉素耐药肠球菌(VRE)的检出率粪肠球菌为0.5%(5株),屎肠球菌为2.4%(24株)。粪肠球菌对呋喃妥因、磷霉素和氨苄西林的耐药率≤10%;屎肠球菌除对糖肽类抗生素、利奈唑胺和磷霉素外,对其他测试药的耐药率在40%～94%。大肠埃希菌对碳青霉烯类抗生素的耐药率较同期其他标本分离株略低,铜绿假单胞菌和不动杆菌属细菌对之耐药率则较低。在部分肠杆菌科细菌和不发酵糖革兰阴性杆菌中检出少数泛耐药菌株。结论尿标本分离菌主要为大肠埃希菌、其次为肠球菌属细菌,两者约占70%。VRE的检出率为2.4%。与其他标本分离菌相比,尿标本中分离的大肠埃希菌、铜绿假单胞菌和不动杆菌属细菌对碳青霉烯类抗生素的耐药率较低。不同医院尿培养分离菌对常用抗菌药的耐药率较低,且有很大差异,提示治疗尿路感染应根据本单位细菌耐药性监测资料选用抗菌药物。
Abstract： Objective To investigate the bacterial distribution and resistance to antibiotics in urine specimens across 14 teaching hospitals in several regions of China. MethodsTwelve general hospitals and two childrenrs hospitals were involved in this program. Bacterial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method. Results were analyzed according to the breakpoints of CLSI 2010. Results A total of 9 301 clinical isolates were collected from urine specimens from January to December 2010, accounting for 19.4% of all the clinical isolates during the same period （9 301/47 850）. Of the 9 301 isolates, 74.2% （6 898/9 301） were gram negative organisms, 25.8% （2 403/9 301） were gram-positive. E. coli was the most prevalent species, accounting for 49.0%, followed by Enterococcus spp. （22.1%）. About 68 % of the strains were isolated from hospitalized patients, 32% of the strains from outpatients and emergency patients. About 64% of the strains were isolated from female patients, 32% from male patients. The prevalence of ESBLs-producing strains in E. coli, Klebsiella spp. （K. pneurnoniae and K. oxytoca ） and P. mirabilis w 58.4 %, 59.8% and 14.4%, similar to the prevalence in other specimens during the same period. A small number of vancomycin-resistant strains were identified in E. faecalis and E. faeciurn . The prevalence of VRE was 0. 5% （n = 5） in E. faecalis and 2.4% （n = 24） in E. faeciurn. Fewer than 10% of the E. faecalis isolates were resistant to nitro- furantoin, fosfomycin or ampicillin. The E. faecium isolates were mostly （40% to 94%） resistant to the antibiotics tested ex- cept glycopeptides, linezolid and fosfomycin. The percentage of the carbapenem-resistant E. coli strains was slightly lower than the corresponding data in other specimens during the same period. P. aeruginosa and Acinetobacter spp. strains showed lower resistance to earbapenems in comparison to the data in other specimens. A few pan-resistant strains were identified in some En- terobacteriaceae and non-fermentative species. Conclusions E. coli is the leading clinical isolates in urine, followed by Entero- coccus, adding up to 70% of all the isolates in urine. The prevalence of VRE is 2.4%. The E. coli, P. aeruginosa and Acine- tobacter spp. isolated from urine showed lower resistance to earbapenems compared with the clinical isolates from other speci- mens. The clinical isolates from urine showed variable but relatively lower resistance to the commonly used antimicrobial agents in different hospitals. Appropriate treatment of urine tract infection should be based on the in-house antibiotic resistance data.
出处
《中国感染与化疗杂志》
CAS
北大核心
2012年第4期241-250,共10页
Chinese Journal of Infection and Chemotherapy
关键词
尿液标本
细菌耐药性监测
细菌药物敏感试验
大肠埃希菌
泛耐药革兰阴性杆菌
万古霉素耐药肠球菌
urine specimen
bacterial resistance surveillance
bacterial susceptibility testing
E. coli
multi-drug re-sistant bacterium
panresistant gram-negative bacillus
vancomycin-resistant Enterococcus
