2005—2014年CHINET大肠埃希菌耐药性监测

发布时间：2018-04-12 23:00

本文选题：大肠埃希菌 + 耐药性监测　；参考：《中国感染与化疗杂志》2016年02期

【摘要】：目的了解中国2005—2014年,CHINET所属19所医院临床分离大肠埃希菌的耐药情况。方法按照统一方案,采用统一材料、方法和判断标准,进行临床分离大肠埃希菌耐药性监测,并用WHONET5.6软件进行数据分析。结果2005—2014年共收集19所医院临床分离的大肠埃希菌97 493株,其中75.5%来自住院患者;49.8%菌株分离自尿液标本。10年间,大肠埃希菌的检出率呈稳步上升趋势:2005年为17.3%,2014年为20.9%。药敏试验结果显示,不同医院分离出的大肠埃希菌对不同种类抗菌药物的耐药性各具特点。10年间,细菌对各种抗菌药物的耐药性发生一定变化,对部分第二代、第三代头孢菌素耐药率呈稳定上升趋势,如对头孢呋辛的耐药率由52.8%上升到62.8%、对头孢他啶由14.9%上升到28.8%等;但对氨基糖苷类抗生素耐药性有缓慢下降趋势,如对阿米卡星由12.0%降至4.0%、对庆大霉素由60.4%降至46.6%、对妥布霉素由30.3%降至19.0%;对碳青霉烯类抗生素的耐药率稳定在0.2%~2.2%;对酶抑制剂复方制剂除氨苄西林-舒巴坦的耐药率已超过50%外,对其余品种的耐药率均20%。ICU分离菌的耐药率明显高于其他科室的分离菌,门诊和住院患者分离菌的耐药率也有明显差别(P0.05)。不同标本来源的大肠埃希菌对不同种类抗菌药物的耐药率有一定的差异,呼吸道标本分离菌对青霉素、头孢菌素类的耐药率明显高于其他标本的分离株。从不同患者分离出的菌株,对抗菌药物的耐药率存在老年人成人儿童新生儿。不同年份,不同医院产ESBL大肠埃希菌的检出率也不尽相同,10年间所有菌株ESBL的总检出率为42.3%,观察期间产ESBL大肠埃希菌的检出率总体呈上升趋势,2014年检出率最高,达55.5%。产ESBL大肠埃希菌对检测的各种抗菌药物的耐药率远高于非产ESBL菌株(P0.05)。结论不同医院、不同科室、不同标本中分离的大肠埃希菌对常用抗菌药物的耐药性有着不同的特点。各医院应继续加强细菌耐药监测工作,以指导抗生素的合理选用。
[Abstract]:Objective to investigate the drug resistance of Escherichia coli isolated from 19 hospitals in China from 2005 to 2014.Methods according to the unified scheme, the drug resistance of clinical isolates of Escherichia coli was monitored by uniform materials, methods and criteria, and the data were analyzed by WHONET5.6 software.Results 97,493 strains of Escherichia coli were collected from 19 hospitals from 2005 to 2014, of which 75.5% were isolated from urine samples. The detection rate of Escherichia coli was steadily increasing in the past 10 years: 17.3% in 2005 and 20.9% in 2014.The results of drug sensitivity test showed that the resistance of Escherichia coli isolated from different hospitals to different kinds of antimicrobial agents had its own characteristics. During the past 10 years, the drug resistance of bacteria to various kinds of antimicrobial agents changed to some extent.The resistance rate of the third generation cephalosporins increased steadily, such as cefuroxime resistance from 52.8% to 62.8%, ceftazidime from 14.9% to 28.8%, but the resistance to aminoglycoside antibiotics decreased slowly.The drug resistance rate of 20%.ICU isolates to other strains was significantly higher than that of other departments, and there was a significant difference between outpatients and inpatients.The resistance rate of Escherichia coli from different samples to different kinds of antimicrobial agents was different. The resistance rate of isolated bacteria from respiratory tract to penicillin and cephalosporins was significantly higher than that of other isolates.The rate of antibiotic resistance of strains isolated from different patients existed in the aged adult children and newborns.In different years, the detection rate of Escherichia coli producing ESBL in different hospitals was different. The total detection rate of all strains of ESBL was 42.3 in 10 years. During the observation period, the detection rate of Escherichia coli produced by ESBL showed an overall upward trend, and the detection rate reached the highest in 2014, reaching 55.5.The resistance rate of Escherichia coli producing ESBL to various antimicrobial agents detected was much higher than that of non-producing ESBL strain (P0.05).Conclusion the drug resistance of Escherichia coli isolated from different hospitals, departments and specimens to common antimicrobial agents is different.Hospitals should continue to strengthen the monitoring of bacterial resistance in order to guide the rational selection of antibiotics.
【作者单位】：安徽医科大学第一附属医院;上海交通大学医学院附属瑞金医院;复旦大学附属儿科医院;北京协和医院;复旦大学附属华山医院;昆明医科大学第一附属医院;上海交通大学附属儿童医院;广州医科大学附属第一医院;浙江大学附属第一医院;甘肃省人民医院;新疆医科大学第一附属医院;天津医科大学总医院;北京医院;四川大学华西医院;浙江大学医学院附属邵逸夫医院;华中科技大学同济医学院附属同济医院;重庆医科大学附属第一医院;中国医科大学附属第一医院;内蒙古医科大学附属医院;
【基金】：国家自然科学基金(81171618)
【分类号】：R446.5

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