2012年中国西南地区Whire Union血流感染病原菌监测

目的了解2012年中国西南地区Whire Union监测网中血流感染患者病原菌的分布及耐药状况，为血流感染的预防和控制提供依据。方法使用WHONET5.5和SPSS19.0软件对西南地区3所三级甲等教学医院2012年分离的血培养菌株进行回顾性分析。结果共分离出病原菌1 745株，包括革兰阴性菌868株(49.74％)和革兰阳性菌877株(50.26％)。革兰阳性菌中常见菌为凝固酶阴性葡萄球菌(61.69％)、肠球菌属(16.31％)和金黄色葡萄球菌(14.60％)。革兰阴性菌中常见菌依次为大肠埃希菌 (43.66％)、克雷伯菌属 (19.59％)、不动杆菌属（9.45%）和沙门菌属（6.68%）。血流感染中，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37.5％和85.4％。屎肠球菌对万古霉素的耐药率为6.3%，暂未发现对万古霉素耐药的粪肠球菌；粪肠球菌和屎肠球菌对利奈唑胺的耐药率分别为1.4％和7.9％；屎肠球菌对多数常用抗菌药物的耐药率显著高于粪肠球菌。大肠埃希菌、克雷伯属和肠杆菌属细菌对亚胺培南的耐药率分别为0.7％、3.6％和11.1％。不发酵糖革兰阴性杆菌对碳青霉烯类抗生素耐药率较高，铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为25.0％和79.1％。血流感染发生前使用过抗菌药物或住重症监护病房（ICU）患者更易感染MRSA与多重耐药鲍曼不动杆菌。进行气管切开/插管的患者更易感染多重耐药鲍曼不动杆菌。结论我国西南地区血流感染的常见病原菌为凝固酶阴性葡萄球菌、大肠埃希菌、克雷伯菌、肠球菌和金黄色葡萄球菌。血培养分离株对常用抗菌药耐药情况复杂，其中MRSA检出率低于全国监测水平，对万古霉素耐药的肠球菌分离率较高。革兰阴性杆菌中肠杆菌科细菌对亚胺培南耐药率存在属间差异，而非发酵菌特别是不动杆菌的耐药形势严峻。抗菌药物的使用或有创性诊疗操作可导致耐药菌感染的发生，故合理应用抗菌药物，加强医院感染控制应成为减少细菌耐药发生的重要策略。

英文摘要:

Objective To test the susceptibility of blood culture isolates to antibiotics in a sample of hospitals in Southwestern China in 2012. Methods Blood culture samples were taken and tested from the patients under the Whire Union surveillance in three tertiary hospitals in Southwestern China in 2012. We performed antimicrobial susceptibility analyses on the blood culture isolates using WHONET5.5 and SPSS19.0．Results A total of 1 745 isolates were identified: 877 Gram-positive (50.26％); 868 Gram-negative (49.74％). Coagulase-negative Staphylococcius (CNS，541 strains，31.00％)，Escherichia coli (ECO,379 strains，21.72％)，Klebsiella spp. (170 strains，9.74％)，Enterococcus spp. (143 strains，8.20％) and Staphylococcus aureus (SAU, 128 strains，7.34％) comprised the majority of isolates．Methicillin-resistant was found in 37.5％ of S.aureus and 85.4％ of CNS，respectively．Zero and 6．3％ resistance to vancomycin were found for Enterococcus faecalis and E．faecium, respectively，compared with a 1.4％and 7.9％ resistance to linezolid, respectively. Imipenem-resistance occurred in 0.7% E.coli, 3.6% Klebsiella spp., and 11.1% Enterobacter spp.. Nonfermenters were highly resistant to carbapenems，with an imipenem resistance rate of 25.0% in P.aeruginosa and 79.1% in Acinetobacter baumannii. Antimicrobial usage and critical-care units were identified as risk factors for MRSA and multi-drug-resistant A. baumannii infections. Patients undergoing tracheotomy/endotracheal intubation were likely to develop multi-drug-resistant A. baumannii infections than others. Conclusion CNS， E．coli，Klebsiella spp.，Enterococcus spp. and S．aureuswere the predominant organisms in bloodstream infections in Southwestern China. Low methicillin-resistant rate was found in Staphylococcus aureus But vancomycin-resistant rate was high in E．faecium. Imipenem-resistant rates varied in Enterobacteriaceae: higher in non-fermenting bacteria especially in Acinetobacter spp.. Use of abtimicrobial drugs and invasive procedures can lead to development of antimicrobial drugs-resistance．

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