2005—2014年CHINET老年患者临床分离菌耐药性监测

发布时间：2018-02-28 19:06

本文关键词： 老年患者细菌耐药性监测药物敏感性试验多重耐药菌广泛耐药菌　出处：《中国感染与化疗杂志》2016年03期 　论文类型：期刊论文

【摘要】：目的了解国内不同地区17所医院2005—2014年老年患者临床分离菌的分布特点及其对抗菌药物的耐药性。方法按统一方案,采用纸片扩散法或自动化仪器法进行细菌药敏试验,按照CLSI 2014年标准判读结果。结果共收集老年临床分离菌159 888株,占整体人群的33.1%。10年间,老年患者分离菌株的检出率呈上升趋势:2005年为30.0%,2014年为32.7%。其中革兰阳性菌36 659株,占22.9%;革兰阴性菌123 229株,占77.1%。住院患者分离148 376株,占92.8%。痰液等呼吸道分泌物是细菌的主要分离源,共88 201株,占55.2%。金黄色葡萄球菌(金葡菌)和凝固酶阴性葡萄球菌中MRSA和MRCNS株的平均检出率分别为67.1%和75.9%。甲氧西林耐药株对β内酰胺类抗生素和其他测试药物的耐药率均高于甲氧西林敏感株(MSSA和MSCNS)。葡萄球菌属中均未发现对万古霉素、替考拉宁和利奈唑胺耐药株。屎肠球菌除对利奈唑胺及氯霉素的耐药率低于粪肠球菌外,对其余抗菌药物耐药率均高于粪肠球菌,屎肠球菌和粪肠球菌对万古霉素的耐药率(4.6%,0.4%)高于全国水平(3.2%,0.3%);根据表型推测多数为Van A型或Van B型。肺炎链球菌非脑膜炎株青霉素敏感株(PSSP)比例(78.2%)低于2014年全国成人组(95.0%)。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株分别占67.5%、40.4%和34.3%。碳青霉烯类抗生素依然对肠杆菌科细菌保持良好的抗菌活性,耐药率大多10%,其次为阿米卡星、酶抑制剂复合制剂。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为35.9%和33.0%,鲍曼不动杆菌对两药的耐药率均55.0%。广泛耐药革兰阴性杆菌中铜绿假单胞菌的分离率(4.0%~1.8%)高于同年全国整体分离率(2.1%~1.6%);鲍曼不动杆菌广泛耐药株从2010年起分离率呈现逐年下降趋势(19.2%~15.5%),低于同年的全国水平(21.4%~19.7%);肠杆菌科细菌广泛耐药株从2008年分离到,分离率(0.1%~1.0%)也低于同年全国水平(0.3%~3.2%)。结论老年患者临床分离菌分布情况与耐药性特点不同于全国平均水平。住院患者比例、呼吸道标本比例、不发酵糖革兰阴性杆菌比例均高于全国水平。苛氧菌及肠道致病菌的分离率及耐药率低于全国水平。MRSA、万古霉素耐药肠球菌、产ESBL菌及铜绿假单胞菌中广泛耐药菌分离率及耐药率高于全国水平。经验用药应参考老年人群耐药监测数据,根据药敏试验结果合理选用抗菌药物。
[Abstract]:Objective to investigate the distribution characteristics of clinical isolates of geriatric patients in 17 hospitals in different regions of China from 2005 to 2014 and their resistance to antimicrobial agents. Methods according to the unified scheme, bacterial susceptibility tests were carried out by disk diffusion method or automatic instrument method. Results according to the results of CLSI interpretation on 2014, a total of 159,888 strains of clinical isolates were collected, accounting for 33.10.10 years of the whole population, the detection rate of isolated strains of geriatric patients showed an upward trend: 30.0 in 2005 and 32.7in 2014. Among them, 36,659 were Gram-positive bacteria. There were 123,229 gram-negative bacteria, accounting for 77.1%. 148 376 strains were isolated from hospitalized patients, accounting for 92.88.Respiratory secretions such as sputum were the main source of bacteria isolation, with 88,201 strains. The average detection rates of MRSA and MRCNS strains in Staphylococcus aureus and coagulase-negative staphylococcus were 67.1% and 75.9, respectively. The resistance rates of methicillin-resistant strains to 尾 -lactam antibiotics and other test drugs were high. No vancomycin was found in either MSSA or MSCNS.Staphylococci were not found in the genus Staphylococcus. The resistant rates of teicoplanin and linazolamide were lower than those of Enterococcus faecalis, but the resistance rate of Enterococcus faecium to other antibiotics was higher than that of Enterococcus faecalis. The drug resistance rate of Enterococcus faecium and Enterococcus faecalis to vancomycin (4.60.40) was higher than that of the whole country (3.2%); according to phenotype, most of them were Van A or Van B. The proportion of penicillin sensitive strains of Streptococcus pneumoniae was 78.2% lower than that of the whole country in 2014. Escherichia coli, Klebsiella (Klebsiella pneumoniae and Klebsiella acidogenes) and Proteus mirabilis accounted for 40.4% and 34.3% of ESBL strains, respectively. Carbapenem antibiotics still maintained good antibacterial activity against Enterobacteriaceae. The drug resistance rate was mostly 10%, followed by amikacin, The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 35.9% and 33.0, respectively. The resistance rate of Acinetobacter baumannii to both was 55.0. The isolation of Pseudomonas aeruginosa from extensively resistant gram-negative bacilli. The isolation rate of Acinetobacter baumannii strains has been decreasing year by year since 2010, which is lower than that of the national level of 21.475% in the same year. The widely resistant strains of Enterobacteriaceae were isolated from 2008, and the strains of Acinetobacter baumannii were isolated from 2008. The isolation rate was also lower than the national level of 0.30.20.Conclusion the distribution of clinical isolated bacteria and the characteristics of drug resistance in elderly patients are different from the national average. The isolation rate and drug resistance rate of caustic bacteria and intestinal pathogenic bacteria were lower than those of national level. MRSA, vancomycin resistant Enterococcus, and vancomycin resistant Enterococcus. The isolation rate and drug resistance rate of ESBL producing bacteria and Pseudomonas aeruginosa were higher than those of the whole country.
【作者单位】：北京医院检验科;上海交通大学医学院附属瑞金医院;复旦大学附属华山医院;北京协和医院;浙江大学附属第一医院;华中科技大学同济医学院附属同济医院;广州医科大学附属第一医院;天津医科大学总医院;安徽医科大学第一附属医院;昆明医科大学第一附属医院;浙江大学医学院附属邵逸夫医院;中国医科大学附属第一医院;四川大学华西医院;甘肃省人民医院;新疆医科大学第一附属医院;重庆医科大学附属第一医院;内蒙古医科大学附属医院;
【基金】：人社部留学人员科技活动择优资助项目
【分类号】：R446.5

【相似文献】