家醫(yī)院老年患者病原菌分布與耐藥性分析

1、779家醫(yī)院老年患者病原菌分布與耐藥性分析喻華 鐘敏 黃湘寧 殷琳 劉鑫 張凱 黃文芳* （四川省醫(yī)學(xué)科學(xué)院·四川省人民醫(yī)院檢驗(yàn)科，成都 610072）【摘要】目的 統(tǒng)計(jì)分析2012年我國65歲以上老年患者病原菌分布和細(xì)菌耐藥特點(diǎn)。方法 全國557家三級(jí)醫(yī)院和232家二級(jí)醫(yī)院，按照監(jiān)測方案要求，進(jìn)行目標(biāo)細(xì)菌收集、鑒定和藥敏試驗(yàn)，負(fù)責(zé)單位依據(jù)CLSI2012年標(biāo)準(zhǔn)，用WHONET 5.6軟件對(duì)收集到的監(jiān)測資料進(jìn)行分析和總結(jié)。結(jié)果 65歲老年患者共分離出295649株病原菌，排在前5位依次是大腸埃希菌18.6%、肺炎克雷伯菌14.6%、銅綠假單胞菌11.9%、鮑曼不動(dòng)桿菌10.6%、金黃

2、色葡萄球菌6.4%。大腸埃希菌、肺炎克雷伯菌和奇異變形桿菌ESBLs的產(chǎn)生率分別達(dá)到了61.8%、34.7%和28.5%；腸桿菌科對(duì)碳青霉烯類抗生素仍有較高的敏感性（敏感率>90%），此外對(duì)哌拉西林/他唑巴坦和頭孢哌酮/舒巴坦也有較好的活性，耐藥率均在12.0%以下。非發(fā)酵革蘭陰性菌中銅綠假單胞菌和鮑曼不動(dòng)桿菌對(duì)亞胺培南的耐藥率分別為28.5%和48.5%，而多粘菌素B和頭孢哌酮/舒巴坦有較好的抗菌作用。耐甲氧西林金黃色葡萄球菌（MRSA）和耐甲氧西林凝固酶陰性葡萄球菌（MRCNS）的檢出率分別為51.2%和85.1%，未發(fā)現(xiàn)萬古霉素和利奈唑胺耐藥的葡萄球菌，僅凝固酶陰性葡萄球菌有對(duì)替考

3、拉寧產(chǎn)生耐藥（2.2%）。腸球菌對(duì)萬古霉素、利奈唑胺和替考拉寧的耐藥率均在3.8%以下。耐青霉素肺炎鏈球菌為4.9%。結(jié)論 65歲老年患者感染以革蘭陰性菌為主，且多重耐藥現(xiàn)象嚴(yán)重，急需加強(qiáng)細(xì)菌耐藥監(jiān)測，控制耐藥菌的發(fā)展與傳播。【關(guān)鍵詞】細(xì)菌耐藥監(jiān)測；細(xì)菌感染；老年患者Distribution and analysis of drug resistance of pathogens of patients age more than 65 years in 779 hospitalsYu Hua, , Zhong Min，Huang Xiang-ning, Yin Lin ，Liu Xin，Zh

4、ang Kai, Huang Wen-fang*(Department of Clinical Laboratory, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu 610072)Abstract: Ojective To analyze the distribution and drug resistance characteristics of isolates from patients age more than 65 years in 2012 in Chi

5、na. Methods All the clinical strains were collected and the susceptibility tests were performed in the third class A level 557 hospitals and the second class A level 232 hospitals around China. The susceptibilities of isolates to antimicrobial agents were determined by using CLSI (2012) standards an

6、d the susceptibility data were processed with WHONET5.6 software by centre laboratory. Results A total of 295649 isolates were collected from patients age more than 65 years. The most predominant pathogens were Escherichia coli(18.6%), Klebsiella pneumonia(14.6%), Pseudomonas aeruginosa(11.9%), Acin

7、etobacter baumannii(10.6%), Staphyloccous aureus(6.4%). ESBLs-producing rates of Escherichia coli, Klebsiella pneumonia and Proteus mirabilis were 61.8%、34.7% and 28.5%. A vast majority of Enterobacteriaceae maintained high susceptibility作者簡介：喻華，（1967.10-)，教授/主任技師，主要從事細(xì)菌耐藥性和耐藥機(jī)制研究。*通訊作者：黃文芳，研究員/主任技師

8、，電郵箱: Huangwf2002 rate to carbopenems over 90%. In addition, Piperacillin/tazobactam and Cefoperazone/sulbactam displayed desirable antibacterial activity against Enterobacteriaceae, and resistance rates to these drugs were all below 12%. For non-fermenting gram-negative isolates, resis

9、tance rate of P.aeruginosa and A.baumannii to imipenem were 28.5% and 48.5% respectively. However, Polymyxin B and Cefoperazone/sulbactam demonstrated good antibacterial activity against non-fermenters. The prevalence of methicillin resistance Staphyloccous aureus(MRSA) and methicillin resistance Co

10、agulase negative staphylococcus(MRCNS) reached 51.2% and 85.1%, respectively. Staphyloccous showing resistance to vancomycin and linezolid. CoNS showed resistance to teicoplanin at 2.2%. Resistance rates of Enterococcus spp. to vancomycin, linezolid and teicoplanin were less than 3.8%. The resistanc

11、e rate of Streptococcus pheumoniae to penicillin was 4.9%. Conclusion The bacterial infection of patients age more than 65 years was mainly caused by gram-negative bacterials and the phenomenon of muti-drug resistance was serious. It was indispensable to enhance resistance surveillance and control t

12、he development and dissemination of drug resistance bacterials.Key Words: antimicrobial resistance surveillance; bacterial infection; patients age more than 65 years隨著我國老齡化社會(huì)的邁進(jìn)，老年住院患者在醫(yī)院的比例日益增高，這些患者由于基礎(chǔ)疾病多，免疫功能低下，極容易發(fā)生下呼吸道的感染。了解我國老年患者主要病原菌分布和耐藥情況，對(duì)臨床合理選擇有效抗生素進(jìn)行治療以降低感染率和死亡率顯得尤為重要。為此我們對(duì)全國779家醫(yī)院65歲以上老

13、年患者病原菌分布與耐藥特點(diǎn)進(jìn)行了統(tǒng)計(jì)分析，現(xiàn)將結(jié)果報(bào)道如下：1材料與方法1.1細(xì)菌來源 收集2012年全國557家三級(jí)醫(yī)院、232家二級(jí)醫(yī)院臨床病原菌菌株資料，對(duì)>65歲患者的資料進(jìn)行分析，所有標(biāo)本均為非重復(fù)菌株。1.2 細(xì)菌鑒定及藥敏試驗(yàn)1.2.1細(xì)菌鑒定 采用VITEK系統(tǒng)、API系統(tǒng)、BD100系統(tǒng)或手工方法進(jìn)行細(xì)菌鑒定。 1.2.2藥敏試驗(yàn) 采用VITEK系統(tǒng)、BD系統(tǒng)、ATB系統(tǒng)進(jìn)行MIC的測定。藥敏紙片法：采用紙片擴(kuò)散法為主（Kirby-Bauer法），藥敏紙片使用BBL公司或Oxoid公司生產(chǎn)的商品，普通細(xì)菌藥敏試驗(yàn)培養(yǎng)基使用MH瓊脂，流感嗜血菌藥敏試驗(yàn)使用HTM培養(yǎng)基，肺

14、炎鏈球菌使用5%羊血M-H瓊脂培養(yǎng)基。1.3 質(zhì)量控制 按照CLSI要求進(jìn)行質(zhì)量控制。質(zhì)控菌株包括：大腸埃希菌ATCC 25922、金黃色葡萄球菌ATCC 25923、金黃色葡萄球菌 ATCC 29213、肺炎克雷伯菌ATCC 700603、陰溝腸桿菌 ATCC 700323、銅綠假單胞菌ATCC 27853、肺炎鏈球菌ATCC 49619和流感嗜血桿菌ATCC 49247。在實(shí)驗(yàn)條件穩(wěn)定下實(shí)行每周1次進(jìn)行常規(guī)質(zhì)量控制程序。1.4 數(shù)據(jù)分析 藥敏結(jié)果判斷標(biāo)準(zhǔn)按照CLSI 2012標(biāo)準(zhǔn)1。所得結(jié)果用WHONET 5.6軟件進(jìn)行分析。2 結(jié)果2.1 細(xì)菌分布及標(biāo)本來源65歲以上患者共分離出2956

15、49株細(xì)菌，革蘭陰性菌中分離率最高的是大腸埃希菌55051株，占18.6%；其次為肺炎克雷伯14.6%、銅綠假單胞菌11.9%、鮑曼不動(dòng)桿菌10.6%；革蘭陽性菌中分離率排列前三位的分別是金黃色葡萄球菌6.4%、屎腸球菌2.9%和糞腸球菌2.8%，見表1。明確標(biāo)本來源細(xì)菌252602株，52.9%菌株來自痰液等呼吸道標(biāo)本中，其余依次分離自尿液20.8%、血液7.5%、分泌物4.2%、和膿液1.7%等，細(xì)菌感染以呼吸道感染為主。表1. 老年患者主要病原菌分布及構(gòu)成比Table1. The majority of isolates and distribution of patients of o

16、ld yearsOrganismNo. of strainsConstituent ratio(%)Escherichia coliKlebsiella pneumoniaePseudomonas aeruginosaAcinetobacter baumanniiStaphylococcus aureusEnterobacter cloacaeStenotrophomonas maltophiliaEnterococcus faeciumEnterococcus faecalisStaphylococcus epidermidisProteus mirabilisStaphylococcus

17、haemolyticusKlebsiella oxytocaStreptococcus pneumoniaeEnterobacter aerogenes55051431613498631258188221147791358668836871705601471039233820334718.6%14.6%11.9%10.6%6.4%3.9%3.1%2.9%2.8%2.4%1.9%1.6%1.3%1.3%1.1%2.2主要革蘭陰性菌對(duì)抗菌藥物的耐藥性 2.2.1主要產(chǎn)ESBLs的腸桿菌科細(xì)菌產(chǎn)ESBLs的腸桿菌科主要有大腸埃希菌、肺炎克雷伯菌和奇異變形桿菌3種，其ESBLs的產(chǎn)生率分別達(dá)到了61.

18、8%、34.7%和28.5%。大腸埃希菌和肺炎克雷伯對(duì)碳青霉烯類抗生素耐藥率最低（1.7%-5.2%），其次為阿米卡星（6.9%-7.9%）。3種細(xì)菌對(duì)哌拉西林/他唑巴坦和頭孢哌酮/舒巴坦也保持較高的活性（敏感率>77.1%）。大腸埃希菌對(duì)喹諾酮類抗生素耐藥率較高（61.8%-64.9%），其次是變形桿菌（27.9%-45.7%）。3種細(xì)菌對(duì)氨基糖苷類中的慶大霉素耐藥率（26.4%-50.1%）明顯高于妥布霉素耐藥（12.2%-24.4%）。由于產(chǎn)ESBLs細(xì)菌增多，使大腸埃希菌對(duì)頭孢菌素類抗生素耐藥率明顯增高。表2 大腸埃希菌等3種細(xì)菌對(duì)抗菌藥物的耐藥情況Table2 The resi

19、stance ratio of 3 bacterial such as Escherichia coli to antimicrobial agentsAntibiticsE.coli（n=55051）K.pneumoniae(n=43161)P.mirabilis（n=5601）No.RISNo.RISNo.RISAmpicillin44443 86.4 2.1 11.5 35295 86.3 10.8 2.8 4626 62.3 2.7 35.0 Piperacillin33229 73.0 7.1 20.0 26297 44.0 9.3 46.8 3479 29.0 12.4 58.5

20、Amoxicillin-clavulanic acid21147 28.2 25.2 46.7 16868 24.0 14.1 61.9 2096 19.2 13.8 67.0 Cefoperazone-sulbactam21046 6.6 16.3 77.1 16711 8.0 12.8 79.2 2032 1.9 5.8 92.3 Ampicillin-sulbactam39735 51.6 18.9 29.5 31813 35.5 7.9 56.6 4240 30.1 11.5 58.4 Ticarcillin-clavulanic acid9070 22.4 25.4 52.2 721

21、1 19.8 14.4 65.8 881 4.8 5.0 90.2 Piperacillin-tazobactam46036 5.1 6.1 88.8 36355 8.4 6.7 84.9 4799 2.0 2.8 95.2 Cefazolin41246 79.3 9.3 11.4 32688 55.5 16.3 28.2 4204 66.4 19.2 14.3 Cefoperazone3237 57.9 7.3 34.8 2817 31.8 5.2 63.0 298 25.5 13.4 61.1 Cefuroxime26189 63.3 4.0 32.7 20565 37.4 4.0 58.

22、6 2599 42.3 2.8 54.9 Ceftazidime50268 33.1 6.2 60.8 39576 22.4 5.7 71.9 5194 9.5 4.0 86.5 Ceftriaxone39605 66.7 0.7 32.6 31903 41.6 1.4 57.0 4021 38.2 3.0 58.8 Cefotaxime27637 71.5 1.8 26.6 21716 49.7 3.6 46.7 2858 45.6 3.3 51.1 Cefepime50504 29.7 6.3 64.0 40274 16.3 3.5 80.2 5187 11.4 3.2 85.4 Cefo

23、xitin22956 16.3 8.2 75.5 18529 16.5 3.8 79.6 2315 7.9 5.1 87.0 Cefaclor2327 60.9 2.0 37.1 1785 41.9 2.9 55.2 236 36.9 1.3 61.8 Aztreonam41707 47.2 4.3 48.5 33472 28.8 3.5 67.6 4270 15.5 1.9 82.6 Imipenem48227 22.995.138785 5.24.690.24352 -10.0 59.8 Meropenem28227 1.71.596.822639 4.52.393.22972 5.0 1

24、.7 93.3 Amikacin50597 6.9 2.2 90.9 40026 7.9 1.4 90.7 5198 6.9 2.7 90.4 Gentamicin47882 50.1 1.4 48.5 3769226.4 1.3 72.3 4929 35.0 7.3 57.6 Tobramycin28658 26.4 23.5 50.1 2291313.7 12.2 74.0 3059 19.2 21.2 59.6 Ciprofloxacin47110 64.9 3.1 32.0 3696322.7 4.3 73.0 4727 45.7 9.1 45.1 Levofloxacin43523

25、61.8 4.4 33.8 3538718.0 3.3 78.7 4491 27.9 12.3 59.8 Chemitrim47976 71.8 0.4 27.8 3805946.7 0.7 52.6 4959 72.0 0.4 27.6 Fosfomycin1720 8.4 1.8 89.8 94922.0 8.6 69.4 166 30.7 2.4 66.9 Furadantin27016 7.1 13.2 79.7 1945633.9 41.3 24.8 2668 95.8 2.3 1.9 Chlormycetin4628 31.1 7.9 61.0 417329.8 4.6 65.6

26、528 56.1 5.1 38.8 Minocycline5180 25.0 14.3 60.7 408325.7 14.9 59.4 483 78.0 10.8 11.2 Achromycin1082671.7 2.2 26.1 866936.8 2.5 60.7 114894.4 1.9 3.7 2.2.2 主要產(chǎn)AMPC酶的腸桿菌科細(xì)菌產(chǎn)氣腸桿菌、弗氏檸檬酸桿菌、粘質(zhì)沙雷菌和陰溝腸桿菌易產(chǎn)生AMPC酶。這4種細(xì)菌對(duì)阿米卡星耐藥性最低（6.5%-9.2%）；其次為碳青霉烯類抗生素亞胺培南和美洛培南（7.1%-9.8%）；加酶抑制劑頭孢哌酮/舒巴坦和哌拉西林/他唑巴坦也保持較高的活性，耐藥率

27、為（6.4%-11.1%）；常用的頭孢類抗生素頭孢吡肟、頭孢他啶和頭孢曲松等耐藥率為16.1%-80.5%，見表3。表3. 產(chǎn)氣腸桿菌等4種細(xì)菌對(duì)抗菌藥物的耐藥情況Table 3. The resistance ratio of 4 bacterials such as Enterobacter aerogenes to antimicrobial agentsAntibitics E.aerogenes（n=3347）C.freundii(n=2281)S.marcescens（n=3350） E.cloacae(n=11477)No.RISNo.RISNo.RISNo.RISAmpicil

28、lin2457 78.4 13.0 8.6 1688 79.1 6.3 14.6 2247 74.0 19.1 6.9 8133 79.9 13.2 6.9 Piperacillin2110 40.5 8.4 51.1 1456 53.7 9.6 36.7 2033 23.2 5.9 70.9 7286 36.6 7.5 56.0 Amoxicillin-clavulanic acid1358 81.8 7.1 11.1 1076 71.8 14.0 14.2 1193 84.1 9.0 6.8 4656 86.2 6.9 6.8 Cefoperazone-sulbactam1095 7.1

29、15.6 77.3 862 10.8 14.2 75.0 1055 5.2 9.8 85.0 4188 9.5 12.9 77.6 Ampicillin-sulbactam2211 54.9 9.8 35.2 1504 60.5 9.5 30.1 2110 62.0 17.3 20.7 7373 57.1 12.1 30.7 Ticarcillin/-clavulanic acid671 27.4 18.7 53.9 490 37.2 16.2 46.6 599 11.6 9.8 78.5 2159 28.7 17.2 54.1 Piperacillin-tazobactam2840 10.5

30、 14.8 74.7 1898 8.9 11.1 80.0 2733 6.4 5.4 88.2 9543 11.0 9.5 79.4 Cefazolin2604 92.7 4.0 3.3 1794 94.0 1.7 4.3 2501 99.1 0.4 0.5 8760 96.8 1.6 1.6 Cefoperazone152 30.3 14.5 55.2 123 33.3 8.9 57.8 139 25.9 7.9 66.2 771 32.7 11.3 56.0 Cefuroxime1422 52.0 5.6 42.4 1006 55.3 5.7 39.1 1316 89.6 5.9 4.6

31、5240 50.7 11.8 37.4 Ceftazidime3133 33.1 7.3 59.6 2098 37.7 6.9 55.4 3017 12.7 6.5 80.8 10602 33.7 6.2 60.1 Ceftriaxone2444 50.7 2.1 47.3 1733 59.3 2.1 38.7 2286 30.7 2.7 66.6 8328 48.3 2.6 49.1 Cefotaxime1709 60.8 4.3 34.9 1244 66.2 4.9 28.9 1642 48.3 6.5 45.2 5949 58.4 4.9 36.7 Cefepime3140 16.1 3

32、.4 80.5 2133 18.9 3.5 77.6 2988 11.0 3.1 85.9 10725 14.6 3.6 81.8 Cefoxitin1464 80.5 4.3 15.2 1143 74.5 6.1 19.4 1262 42.1 27.6 30.3 4840 87.9 3.9 8.2 Cefaclor96 71.9 2.1 26.0 88 82.9 5.7 11.4 113 95.6 0.0 4.4 491 76.4 6.1 17.5 Aztreonam2647 37.5 4.3 58.2 1814 44.1 4.5 51.4 2466 23.0 3.4 73.6 8926 4

33、0.1 3.6 56.2 Imipenem2969 9.3 9.3 81.4 2029 9.2 5.7 85.1 2811 8.2 11.2 80.6 10349 7.2 5.1 87.7 Meropenem1690 9.8 2.5 87.7 1155 7.1 2.9 90.0 1595 6.3 2.3 91.4 6209 7.2 2.3 90.6 Amikacin3140 6.5 1.5 92.0 2155 9.2 1.9 88.9 3017 7.6 1.2 91.2 10802 6.7 3.0 90.3 Gentamicin2972 18.3 1.5 80.2 2003 38.3 2.4

34、59.3 2855 17.0 1.1 81.9 10057 21.2 3.8 75.0 Tobramycin1906 14.0 5.4 80.6 1222 25.5 12.9 61.6 1764 10.2 9.8 79.9 6161 19.6 7.5 72.9 Ciprofloxacin2915 16.0 5.6 78.4 1941 37.4 7.3 55.3 2784 13.3 4.3 82.4 10029 19.6 4.2 76.2 Levofloxacin2783 12.2 4.4 83.4 1912 27.4 7.7 64.9 2681 8.4 5.2 86.4 9335 15.6 3

35、.3 81.1 Chemitrim2947 38.6 0.8 60.6 1993 60.3 0.3 39.4 2842 26.1 0.5 73.4 9995 45.4 0.3 54.2 Fosfomycin88 14.8 6.8 78.4 71 16.9 7.0 76.1 71 19.7 2.8 77.5 192 14.1 6.2 79.7 Furadantin1433 36.2 49.5 14.2 1058 10.3 11.4 78.3 1399 96.9 0.7 2.4 5087 22.2 47.9 29.9 Chlormycetin350 24.9 7.1 68.0 201 26.4 9

36、.5 64.1 316 35.1 44.3 20.6 1203 30.0 4.2 65.8 Minocycline310 19.4 21.6 59.0 215 32.1 12.1 55.8 284 7.4 13.7 78.9 1104 23.7 16.1 60.2 Achromycin73632.2 2.9 64.9 54952.7 2.0 45.3 62556.8 16.8 26.4 241332.3 3.5 64.2 2.2.3 主要非發(fā)酵革蘭陰性桿菌非發(fā)酵細(xì)菌銅綠假單胞菌對(duì)各種抗菌藥物耐藥率在8.4-35.4%之間，而鮑曼不動(dòng)桿菌的耐藥情況嚴(yán)重，除多粘菌素B、米諾環(huán)素和頭孢哌酮/舒巴坦外

37、，大多數(shù)藥物的耐藥率均在45.0%以上，見表4。表4. 銅綠假單胞菌和鮑曼不動(dòng)桿菌對(duì)抗菌藥物的耐藥情況Table4. The resistance ratio of P.aeruginosa and A.baumannii to antimicrobial agentsAntibitics P.aeruginosa（n=34986）A.baumannii(n=31258)No.RISNo.RISPiperacillin25933 26.1 15.7 58.2 2022958.98.033.1Cefoperazone-sulbactam14593 13.4 17.4 69.2 1365220.8

38、24.055.2Piperacillin-tazobactam30370 15.9 17.3 66.7 2470050.86.442.8Ceftazidime32504 19.5 7.6 72.9 28698Cefepime32156 18.3 10.9 70.8 2848653.16.040.9Imipenem30635 28.5 7.3 64.2 2706448.53.448.1Meropenem21904 26.3 8.2 65.5 1703247.04.548.4Amikacin31988 12.3 4.0 83.7 2514638.43.757.8Gentami

39、cin30892 22.2 7.0 70.8 27363Tobramycin22120 18.5 2.4 79.1 1840846.92.950.2Ciprofloxacin30751 21.4 6.8 71.8 2779357.02.041.0Levofloxacin2865021.4 7.2 71.4 2531745.310.344.4Polymyxin B67278.4 0.9 90.7 53552.60.497.0Ticarcillin-clavulanic acid10593 35.4 32.5 32.1 Chemitrim2688362.70.736.6Amp

40、icillin-sulbactam2145951.07.941.1Ceftriaxone2146556.729.114.2Aztreonam2676728.119.052.9Minocycline874725.713.0 嗜血桿菌嗜血桿菌屬對(duì)所測的大部分藥物的敏感率高于85%。除氟喹諾酮類藥物外，流感嗜血桿菌和副流感嗜血桿菌對(duì)其它抗生素的敏感率基本相當(dāng)。對(duì)氟喹諾酮類藥物，副流感嗜血桿菌的耐藥率比流感嗜血桿菌高2倍以上，見表5。表5 流感嗜血桿菌和副流感嗜血桿菌對(duì)抗菌藥物的耐藥情況Table5 The resistance ratio of H.influenza and H.

41、parainfluenzae to antimicrobial agentsAntibitics H.influenza（n=1747）H.parainfluenzae(n=608)No.RISNo.RISAmpicillin1443 37.6 6.2 56.2 299 43.8 7.9 48.2 Amoxicillin-clavulanic acid770 10.1 0.0 89.9 201 12.1 0.0 87.9 Ampicillin-sulbactam635 16.1 0.0 83.9 206 13.6 0.0 86.4 Piperacillin-tazobactam82 1.2 0

42、.0 98.8 Cefuroxime1145 9.4 3.3 87.3 298 8.3 4.5 87.2 Ceftazidime486 0.4 11.5 88.1 93 9.7 0.0 90.3 Ceftriaxone310 0.3 7.4 92.3 120 15.8 0.0 84.2 Cefotaxime1121 0.4 5.8 93.8 202 11.9 0.0 88.1 Cefepime261 0.0 7.7 92.3 70 2.9 0.0 97.1 Aztreonam664 12.7 0.2 87.1 160 26.2 0.0 73.8 Imipenem490 2.4 0.0 97.6

43、 152 3.9 0.0 96.1 Meropenem543 8.6 0.2 91.2 104 3.8 0.0 96.2 Rifampilin448 10.6 6.4 83.1 109 15.6 3.7 80.7 Ciprofloxacin924 14.8 0.0 85.2 143 29.5 0.0 70.5 Levofloxacin734 8.3 0.0 91.7 142 21.2 0.0 78.8 Moxifloxacin43 2.3 0.0 97.7 Chemitrim1352 61.5 4.2 34.3 29455.5 8.7 35.8 Azithromycin692 11.2 0.0

44、 88.8 19912.0 0.0 88.0 Chlormycetin81717.5 7.5 75.0 16514.5 9.7 75.8 Achromycin90928.0 8.2 63.8 13425.4 2.3 72.3 2.3主要革蘭陽性菌對(duì)抗菌藥物的耐藥性 2.3.1 葡萄球菌屬耐甲氧西林金黃色葡萄球菌和耐甲氧西林凝固酶陰性葡萄球菌的分離率分別為51.2%、85.1%；未發(fā)現(xiàn)對(duì)萬古霉素和利奈唑胺耐藥的金黃色葡萄球菌和；僅在凝固酶陰性葡萄球菌有對(duì)替考拉寧耐藥株，耐藥率為2.2%，見表6。表6 葡萄球菌對(duì)抗菌藥物的耐藥率和敏感率(%)Table6 The resistance and se

45、nsitivity percentage of Staphylococcus to antibiotics(%)Antibitics S.aureusa（n=18822）Coagulase negative staphylococcus(n=77162)No.RISNo.RISPenicillin G16518 93.9 0.0 6.1 15861 93.5 0.0 6.5 Ampicillin3786 96.2 0.0 3.8 1268994.5014.9Oxacillin15197 51.2 0.2 48.6 3711 85.10.0 5.5 Amoxicillin-clavulanic

46、acid4762 51.0 0.0 49.0 3966 52.0 0.1 47.9 Ampicillin-sulbactam1739 47.2 6.9 46.0 1271 40.9 6.1 52.9 Ticarcillin/-clavulanic acid73 57.1 0.0 42.9 51 40.5 0.0 59.5 Piperacillin-tazobactam2593 41.1 0.0 58.9 1675 39.2 0.0 60.8 Cefazolin6627 45.5 3.1 51.4 6027 40.1 3.9 56.0 Cefuroxime2642 47.7 3.5 48.8 2

47、164 43.3 4.3 52.4 Ceftazidime374 41.2 7.8 51.0 134 31.3 8.2 60.5 Ceftriaxone690 35.7 11.3 53.0 449 45.0 12.9 42.1 Cefotaxime660 37.0 13.3 49.7 728 46.6 15.5 37.8 Cefepime596 39.4 3.7 56.9 627 42.8 4.5 52.7 Cefoxitin7269 55.3 0.0 44.7 79 48.1 8.9 43.0 Cefaclor107 43.9 1.9 54.2 2747 45.2 4.1 50.7 Imipenem3257 44.1 1.2 54.7 1147 38.7 2.4 58.9 Meropenem1605 44.5 1.4 54.1 1982 7.4 2.9 89.7 Amikacin2792 33.3 3.6 63.1 15184 39.6 7.4 53.0 Gentamicin16058