目的 统计分析四川省细菌耐药监测网成员单位2015年度病原菌分布及耐药情况,为我省抗菌药物合理应用提供依据.方法 按照监测方案,采用标准纸片扩散法或自动化仪器检测法,测定监测药物对细菌的敏感性,依据CLSI 2015年标准,使用WHONET 5.6软件进行数据统计分析.结果 74家医院参加了2015年度细菌耐药监测工作,其中数据合格纳入分析的共68家,按患者首次分离菌株进行统计分析,共纳入细菌143475株,其中革兰阴性菌104216株(72.6％),革兰阳性菌39259株(27.4％).耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为28.2％和70.9％,未发现对万古霉素、利奈唑胺和替考拉宁耐药的菌株.粪肠球菌和屎肠球菌对万古霉素和利奈唑胺的耐药率分别为0.9％和4.4％,1.0％和0.8％.非脑脊液标本分离的肺炎链球菌对青霉素耐率为1.5％,对红霉素耐药率为91.5％.革兰阴性菌中分离率排前3位的是大肠埃希菌31763株(30.5％)、肺炎克雷伯菌19921株(19.1％)和铜绿假单胞菌12846株(12.3％).大肠埃希菌对头孢曲松、头孢噻肟耐药率在55.0％以上,对喹诺酮类耐药率接近50％;肺炎克雷伯菌对第三代头孢菌素耐药率低于40.0％,对喹诺酮类药物耐药率低于15.0％;耐碳青霉烯的大肠埃希菌和肺炎克雷伯菌检出率分别为2.0％和3.1％.铜绿假单胞菌对多黏菌素B耐药率低于1.0％,耐碳青霉烯的铜绿假单胞菌检出率为15.7％;鲍曼不动杆菌对包括碳青霉烯类的大多数药物耐药率均在50.0％以上.结论 我省细菌耐药情况同以往比较,MRSA呈下降趋势,而耐碳青霉烯类的肠杆菌科细菌、耐万古霉素的肠球菌与广泛耐药的非发酵菌仍呈增长趋势,长期监测有助于了解本地细菌耐药性变迁情况,为临床合理用药提供依据.%Objective To provide the basis for the reasonable application of antimicrobial agents in our province by statistically analyzing pathogenic bacteria distributions and the drug resistance in 2015 using data provided by Sichuan ARSS members.Methods According to the monitoring plan,the method of disc-diffusion or automatic clinical microbiological systems was adopted to determine the bacteria sensitivity against antimicrobial drugs.The WHONET 5.6 software was used to analyze statistical data based on the CLSI 2015 criteria.Results 74 hospitals participated in the bacterial drug resistance monitoring in 2015,with qualified data for analysis from 68 hospitals.By analyzing patients for the first time isolates,a total of 143,475 strains of bacteria were collected,of which 104,216 strains were Gram-negative bacteria (72.6％),and 39,259 strains were Gram-positive bacteria (27.4％).The detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative Staphylococcus (MRCNS) were 28.2％ and 70.9％ respectively.None of the strains were found to be resistant to vancomycin,linezolid and teicoplanin.The drug resistance rate of E.faecalis and E.faecium to vancomycin and linezolid were 0.9％ and 4.4％,1.0％ and 0.8％ respectively.The resistance rate of Streptococcus pneumoniae isolated from non cerebrospinal fluid specimens to penicillin and toerythrocin were 1.5％ and 91.5％ respectively.The Gramnegative bacteria with the top three isolation rates were Escherichia coli (31,763 strains,30.5％),Klebsiella pneumoniae (19,921 strains,19.1％),and Pseudomonas aeruginosa (12,846 strains,12.3％).The drug resistance rates ofE.coli to ceftriaxone and cefotaxime were over 55.0％,and the resistance rate to quinolones was almost 50％.The drug resistance rate ofK.pneumoniae to the third-generation cephalosporin was less than 40％,and to quinolones was less than 15.0％.The detection rates of E.coli and K.pneumoniae resistant to carbapenem antibiotics were 2.0％ and 3.1％ respectively.The resistance rate of P.aeruginosa to polymyxin B was less than 1.0％ and to carbapenem antibiotics was 15.7％.The resistance rate ofA.baumannii to carbapenem antibiotics and other drugs were over 50.0％.Conclusion MRSA was declining in contrast to previous periods,while Enterobacteriaceae bacteria resistant to carbapenem antibiotics and Enterococcus resistant to vancomycin and nonfermenters were rising.Long term monitoring was helpful to understand local antibacterial drug resistance changes,and provided guidance for clinical rational drug use.
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