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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。
Objective To understand the 2016 Shanghai bacterial resistance test results. Methods The clinical isolates from 47 hospitals in Shanghai were tested for susceptibility by disk diffusion method or automated instrument. Including 28 tertiary hospitals (31 373 beds) and 19 secondary hospitals (16 311 beds). CLSI 2016 version of the standard to determine the results. Results 12 522 54 clinical isolates, 35 522 strains of gram-positive bacteria, accounting for 29.0%; 87 026 strains of Gram-negative bacteria, accounting for 71.0%. Separation of secondary and tertiary hospitals accounted for 28.9% and 71.1% respectively, of which Gram-positive bacteria and Gram-negative bacteria accounted for 25.8%, 74.2%, 30.3% and 69.7% respectively in Grade II and Grade III hospitals. The detection rates of MRSA and MRCNS were 48.7% and 77.2% respectively. The average detection rates of MRSA and MRCNS in secondary and tertiary hospitals were 55.9%, 73.3%, 45.9% and 78.6% respectively. Vancomycin resistant strains were not found in Staphylococcus. The detection rates of penicillin-sensitive (PSSP), mediator (PISP) and drug-resistant strains (PRSP) in non-meningitis and pneumococci in 111 children were 77.4%, 13.2% and 9.4% respectively. Accounting for 97.8%, 2.2%, 0 respectively, accounting for 76.5%, 13.7% and 9.8% respectively in tertiary hospitals. 285 isolates of Streptococcus pneumoniae PSSP, PISP and PRSP were 94.0%, 4.2% and 1.8% respectively; the above-mentioned bacteria accounted for 93.7%, 5.3% and 1.0% respectively in secondary hospitals, 94.2% in tertiary hospitals, , 3.7%, 2.1%. 37 Enterococcus faecium (14 secondary hospitals, 23 tertiary hospitals) and 25 Enterococcus faecalis (all isolated from tertiary hospitals) were found to be resistant to vancomycin. According to PCR sequencing, most vancomycin-resistant enterococci (VRE) are of the van A genotype. The detection rates of ESBL in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 52.2%, 30.9% and 29.8%, respectively. The detection rates of ESBL-producing strains in secondary and tertiary hospitals were 55.1%, 33.6%, 34.0% and 51.0%, 29.7% and 28.0% respectively. Enterobacteriaceae are still highly sensitive to carbapenem antibiotics, and the overall resistance rates to imipenem and meropenem are 8.9% and 9.1% respectively. The rates of resistance in secondary and tertiary hospitals are 6.6 %, 7.1% and 9.9%, 10.0%. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli showed extensive resistance to all tested antimicrobials, with 223 strains in secondary and tertiary hospitals, respectively, 63 strains, 10 strains, 4 strains and 224 strains, 201 strains, 22 strains and 9 strains. Conclusion At present, the main clinical pathogenic bacteria are still highly resistant to commonly used antimicrobial agents, posing a serious threat to the medical institutions. Therefore, they should be given high priority and effective measures should be taken.