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目的了解2005-2014年CHINET细菌耐药性监测网中脑脊液分离菌的分布及其耐药性。方法对CHINET细菌耐药性监测网2005-2014年所有脑脊液标本按照常规方法进行细菌分离、培养和鉴定。按统一方案用纸片扩散法或自动化仪器进行分离菌对抗菌药物的敏感性试验。结果 2005-2014年脑脊液标本分离细菌5 340株,其中革兰阳性菌3 285株,占61.5%;革兰阴性菌2 055株,占38.5%。最常见的分离菌依次为凝固酶阴性葡萄球菌、鲍曼不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、粪肠球菌、屎肠球菌、肺炎链球菌、阴沟肠杆菌。脑脊液标本中MRSA和MRCNS的检出率分别为各自菌种的67.6%和69.7%。未发现对万古霉素、利奈唑胺耐药的葡萄球菌。脑脊液标本中产ESBL大肠埃希菌和肺炎克雷伯菌的检出率分别为61.7%和53.4%。脑脊液标本中广泛耐药的鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌的检出率分别为13.5%、6.2%、0.9%。结论 2005-2014年革兰阳性菌,尤其是凝固酶阴性葡萄球菌在中枢神经系统感染中占重要地位。应防范广泛耐药肠杆菌科细菌和鲍曼不动杆菌所致感染对临床造成严重威胁。
Objective To understand the distribution and drug resistance of cerebrospinal fluid (CSF) isolates in the CHINET bacterial resistance surveillance network from 2005 to 2014. Methods All the samples of cerebrospinal fluid of CHINET bacterial resistance surveillance network from 2005 to 2014 were isolated, cultured and identified by routine methods. Sensitivities of the isolates to antimicrobials were tested using a diffusion-sheet method or automated instrument according to a uniform protocol. Results A total of 5340 bacteria were isolated from cerebrospinal fluid samples in 2005-2014, of which 3 285 were Gram-positive bacteria, accounting for 61.5%. There were 2 055 gram-negative bacteria, accounting for 38.5%. The most common isolates were coagulase negative Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecalis, Enterococcus faecium, pneumonia Streptococcus, Enterobacter cloacae. The detection rates of MRSA and MRCNS in cerebrospinal fluid samples were 67.6% and 69.7% respectively. No vancomycin, linezolid-resistant staphylococci were found. The detection rates of ESBL-producing Escherichia coli and Klebsiella pneumoniae in CSF samples were 61.7% and 53.4%, respectively. The detection rates of widely resistant Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa in CSF samples were 13.5%, 6.2% and 0.9% respectively. Conclusions Gram-positive bacteria, especially coagulase-negative staphylococci, played an important role in the CNS infection during 2005-2014. The prevention of widespread resistance to Enterobacteriaceae and Acinetobacter baumannii infection caused serious clinical threat.