2015年CHINET细菌耐药性监测

发布时间：2018-02-27 21:01

本文关键词： 细菌耐药性监测药物敏感性试验多重耐药菌广泛耐药菌万古霉素耐药肠球菌耐甲氧西林葡萄球菌耐青霉素肺炎链球菌碳青霉烯类耐药肠杆菌科细菌　出处：《中国感染与化疗杂志》2016年06期 　论文类型：期刊论文

【摘要】：目的了解国内主要地区临床分离菌对常用抗菌药物的敏感性和耐药性。方法国内主要地区20所医院(18所综合性医院、2所儿童医院)临床分离菌采用纸片扩散法或自动化仪器法按统一方案进行细菌药物敏感性试验。按CLSI2015年版标准判断}P果。结果收集2015年1—12月各医院临床分离菌共88 778株,其中革兰阳性菌26 481株,占29.8%,革兰阴性菌62 297株,占70.2%。金黄色葡萄球菌(金葡菌)和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)的平均检出率分别为42.2%和82.6%。MRSA和MRCNS对β内酰胺类抗生素和其他绝大多数测试药的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。MRSA中有92.3%的菌株对甲氧苄啶-磺胺甲VA唑敏感;MRCNS中有85.4%菌株对利福平敏感。未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物(除氯霉素外)的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株,表型或基因型检测结果显示主要为VanA型、VanB型或VanM型耐药。肺炎链球菌非脑膜炎株儿童株中青霉素敏感株所占比例较2014年有所上升,中介和耐药株的检出率均有所下降,但成人株反之。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中产ESBL株平均分别占51.5%、27.4%和22.2%,产ESBL株对测试药物的耐药率均比非产ESBL株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,绝大多数菌株的耐药率低于10%。不动杆菌属(鲍曼不动杆菌占93.4%)对亚胺培南和美罗培南的耐药率分别为62.0%和70.5%。与2014年相比,肺炎克雷伯菌中广泛耐药株的检出率有所上升。结论肺炎克雷伯菌和鲍曼不动杆菌对碳青霉烯类的耐药率仍呈上升趋势,给临床的抗感染治疗带来极大挑战。
[Abstract]:Objective to investigate the susceptibility and drug resistance of clinical isolates to common antimicrobial agents in 20 hospitals in 20 hospitals and 2 children's hospitals in 20 hospitals in China. The automatic instrument method was used to test bacterial drug sensitivity according to the unified plan. According to the CLSI2015 annual standard, the clinical isolates of 88 778 strains were collected from 2015. Among them, 26,481 were Gram-positive bacteria (29.8B), 62,297 Gram-negative bacteria (Gram-negative bacteria), The average detectable rate of methicillin-resistant strains in Staphylococcus aureus and coagulase-negative staphylococci was 42.2% and 82.6% respectively. MRSA and MRCNS were resistant to 尾 lactam antibiotics and most other test drugs. The drug rates were significantly higher than those of 92.3% strains of methicillin-sensitive strains and MSCNS).MRSA, 85.4% strains of which were sensitive to rifampicin, and no vancomycin was found. The resistance rate of Enterococcus faecalis to most tested antibiotics (except chloramphenicol) was significantly lower than that of Enterococcus faecium, and there were a few vancomycin resistant strains in both strains. Phenotypic or genotypic analysis showed that the main drug resistance was VanA type Van B or VanM type. The proportion of penicillin sensitive strains in children with non meningitis strains of Streptococcus pneumoniae increased compared with 2014, and the detection rate of mediators and resistant strains were decreased. But the adult strain is the opposite. Escherichia coli, Klebsiella (Klebsiella pneumoniae and Klebsiella mirabilis) and Proteus mirabilis accounted for an average of 51.5% and 22.2% of ESBL strains, respectively. The drug resistance rate of ESBL producing strains was higher than that of non-producing ESBL strains. Enterobacteriaceae strains were resistant to carbapenem. Antibiotics are still highly sensitive, The resistance rates of Acinetobacter (Acinetobacter baumannii) to imipenem and meropenem were 62.0% and 70.5, respectively, compared with 2014. Conclusion the resistance rate of Klebsiella pneumoniae and Acinetobacter baumannii to carbapenem is still on the rise, which brings great challenge to clinical anti-infective therapy.
【作者单位】：复旦大学附属华山医院抗生素研究所;复旦大学附属华山医院检验科;北京协和医院;新疆医科大学第一附属医院;四川大学华西医院;复旦大学附属儿科医院;安徽医科大学第一附属医院;华中科技大学同济医学院附属同济医院;上海交通大学医学院附属瑞金医院;中国医科大学附属第一医院;天津医科大学总医院;浙江大学医学院附属邵逸夫医院;昆明医科大学第一附属医院;内蒙古医科大学附属医院;甘肃省人民医院;上海交通大学附属儿童医院;北京医院;广州医科大学附属第一医院;上海市浦东新区人民医院;宁波市镇海龙赛医院;湖北省秭归县人民医院;
【基金】：辉瑞IIR项目(WI207259)
【分类号】：R446.5

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