2016年上海市细菌耐药性监测

发布时间：2018-10-20 13:51

【摘要】：目的了解2016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47所医院的临床分离菌进行药敏试验。包括28所三级医院(床位数31 373张)和19所二级医院(床位数16 311张)。采用CLSI 2016年版标准判断结果。结果 12 2 548株临床分离菌,革兰阳性菌35 522株,占29.0%;革兰阴性菌87 026株,占71.0%。分离菌二级医院和三级医院分别占28.9%和71.1%;其中革兰阳性菌和革兰阴性菌在二、三级医院中分别占25.8%和74.2%、30.3%和69.7%。MRSA和MRCNS的检出率分别为48.7%和77.2%。MRSA、MRCNS在二级医院和三级医院的平均检出率分别为55.9%、73.3%和45.9%、78.6%。葡萄球菌属中未发现万古霉素耐药株。1 111株儿童非脑膜炎肺炎链球菌中青霉素敏感(PSSP)、中介(PISP)和耐药株(PRSP)的检出率分别为77.4%、13.2%和9.4%;上述细菌在二级医院中分别占97.8%、2.2%、0;在三级医院中分别占76.5%、13.7%、9.8%。285株成人分离肺炎链球菌PSSP、PISP和PRSP分别为94.0%、4.2%和1.8%;上述细菌在二级医院中分别占93.7%、5.3%、1.0%;在三级医院中分别占94.2%、3.7%、2.1%。发现37株屎肠球菌(二级医院14株,三级医院23株)和25株粪肠球菌(均分离自三级医院)耐万古霉素。根据PCR测序,多数万古霉素耐药肠球菌(VRE)为van A基因型。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中ESBL的检出率分别为52.2%、30.9%和29.8%。上述产ESBL菌株在二级医院和三级医院的检出率分别为55.1%、33.6%、34.0%和51.0%、29.7%、28.0%。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、美罗培南的总耐药率分别为8.9%、9.1%,二级医院和三级医院中耐药率分别为6.6%、7.1%和9.9%、10.0%。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出现对所有测试抗菌药物耐药的广泛耐药株,在二级医院和三级医院分别为223株、63株、10株、4株和224株、201株、22株、9株。结论目前临床主要病原菌对常用抗菌药物的耐药性仍极严重,对医疗机构构成严重威胁,需引起高度重视并采取有效感控措施。
[Abstract]:Objective to investigate the surveillance results of bacterial resistance in Shanghai in 2016. Methods Drug sensitivity test of clinical isolates from 47 hospitals in Shanghai was carried out by disk diffusion or automatic instrument method. These include 28 level III hospitals (31,373 beds) and 19 level II hospitals (16,311 beds). CLSI 2016 version of the standard judgment results. Results among 122,548 clinical isolates, 35,522 Gram-positive bacteria (29.0%) and 87,026 Gram-negative bacteria (71.0%) were found. The proportion of Gram-positive bacteria and Gram-negative bacteria were 28.9% and 71.1% in the second and third class hospitals respectively, among which Gram-positive bacteria and Gram-negative bacteria were in the second, The detection rates of 69.7%.MRSA and MRCNS were 48.7% and 77.2%, respectively. The average detectable rates of MRCNS were 55.93.3% and 45.9% in the second and third level hospitals, respectively. Vancomycin resistant strains were not found in Staphylococcus spp. The detectable rates of penicillin sensitive (PSSP), mediated (PISP) and resistant strains (PRSP) were 77.2% and 9.4% respectively in 111children with non-meningococcal Streptococcus pneumoniae. The PSSP,PISP and PRSP of Streptococcus pneumoniae isolated from adults were 94.04.2% and 1.8% respectively in the third level hospital, the proportion of the above bacteria in the second grade hospital was 93.75.33% and 1.0, respectively, and the proportion of the above bacteria in the third grade hospital was 94.2n 3.72.1. It was found that 37 strains of Enterococcus faecium were resistant to vancomycin (14 strains in the second class hospital and 23 strains in the third class hospital) and 25 strains of Enterococcus faecalis (all isolated from the third class hospital) were resistant to vancomycin. According to PCR sequencing, most of the vancomycin resistant Enterococcus (VRE) were van A genotypes. The positive rates of ESBL in Escherichia coli Klebsiella pneumoniae and Proteus mirabilis were 52.2% and 29.8% respectively. The detectable rates of the above ESBL producing strains were 55.1% and 51.0% in the second and third level hospitals, respectively, and 28.0% and 51.0%, respectively. Enterobacteriaceae bacteria were still highly sensitive to carbapenem antibiotics. The total drug resistance rates for imipenem and meropenem were 8.9% and 9.1%, respectively. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli showed extensive resistance to all tested antimicrobial agents, There were 223 strains, 63 strains, 10 strains, 4 strains and 224 strains, 201 strains, 22 strains and 9 strains in the second class hospital and the third class hospital respectively. Conclusion the drug resistance of the main clinical pathogens to common antimicrobial agents is still very serious, which is a serious threat to medical institutions.
【作者单位】：复旦大学附属华山医院;长海医院;东方肝胆外科医院;复旦大学附属儿科医院;复旦大学附属妇产科医院;复旦大学附属华东医院;复旦大学附属金山医院;复旦大学附属上海市第五人民医院;复旦大学附属肿瘤医院;复旦大学附属中山医院;上海长征医院;上海交通大学附属第六人民医院;上海交通大学附属第一人民医院;上海交通大学附属儿童医院;上海交通大学医学院附属第九人民医院;上海交通大学医学院附属第三人民医院;上海交通大学医学院附属儿童医学中心;上海交通大学医学院附属瑞金医院;上海交通大学医学院附属瑞金医院北院;上海交通大学医学院附属仁济医院(浦东);上海交通大学医学院附属仁济医院(浦西);上海交通大学医学院附属同仁医院(仙霞路院区);上海交通大学医学院附属新华医院;上海市崇明县中心医院;上海市第八人民医院;上海市第二人民医院;上海市奉贤区中心医院;上海市静安区中心医院;上海市浦东新区公利医院;上海市浦东新区人民医院;上海市浦东医院;上海市普陀区人民医院;上海市普陀区中心医院;上海市青浦区中心医院;上海市松江区中心医院;上海市杨浦区中心医院;上海市第七人民医院;上海中医药大学附属龙华医院;上海中医药大学附属曙光医院;上海中医药大学附属岳阳中西医结合医院;同济大学附属东方医院;上海第十人民医院;同济大学附属同济医院;中国人民解放军第四五五医院;上海市第六人民医院东院;上海市闵行区中心医院;同济大学附属东方医院南院;
【分类号】：R446.5

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