2005—2014年CHINET呼吸道分离菌耐药性监测

发布时间：2018-04-27 23:55

本文选题：呼吸道感染 + 病原菌　；参考：《中国感染与化疗杂志》2016年05期

【摘要】：目的总结2005-2014年CHINET呼吸道分离菌的分布及耐药性。方法CHINET成员单位按统一方案、采用统一的材料,药敏试验采用纸片扩散法(K-B法)、自动化仪器法及E试验法,按照美国CLSI 2014年版标准判读结果,用WHONET 5.6软件统计分析呼吸道标本分离菌的分布及耐药性。结果2005-2014年呼吸道标本共分离出229 170株细菌,其中革兰阴性菌占78.8%,革兰阳性菌占18.4%。常见细菌依次为鲍曼不动杆菌(16.7%)、铜绿假单胞菌(16.5%)、肺炎克雷伯菌(14.8%)、金黄色葡萄球菌(金葡菌)(11.8%)、大肠埃希菌(7.1%)、嗜麦芽窄食单胞菌(5.8%)、阴沟肠杆菌(3.8%)、肺炎链球菌(3.7%)、流感嗜血杆菌(3.1%)等。药敏结果显示,儿童患者中肺炎链球菌青霉素耐药和中介菌株(PRSP、PISP)检出率分别为16.1%、23.5%,明显高于成人患者(3.3%、5.9%),儿童患者中PRSP发生率明显增加,从2006年5.4%上升至2013年21.9%;β溶血链球菌对青霉素和头孢菌素类高度敏感,肺炎链球菌和A群链球菌对红霉素、克林霉素耐药率80%,对氟喹诺酮类、万古霉素、利奈唑胺仍保持较高敏感率。流感嗜血杆菌成人株与儿童株中β内酰胺酶检出率分别为22.7%与36.5%,对阿奇霉素、头孢呋辛、左氧氟沙星敏感率90%。金葡菌中未检出万古霉素、替考拉宁、利奈唑胺耐药株,甲氧西林耐药金葡菌(MRSA)检出率为60.8%。大肠埃希菌对碳青霉烯类最敏感(耐药率3%),其次为头孢哌酮-舒巴坦、哌拉西林-他唑巴坦(耐药率10%)。肺炎克雷伯菌对亚胺培南、美罗培南耐药率逐年增高,分别从2005年3.1%、2.5%上升至2014年10.3%、14.2%,亚胺培南耐药肺炎克雷伯菌仅对替加环素耐药率较低为12.8%。鲍曼不动杆菌对米诺环素、头孢哌酮-舒巴坦、亚胺培南、美罗培南耐药率逐年增加,对替加环素耐药率较低为6.7%。铜绿假单胞菌对主要抗菌药物耐药率逐年降低,对阿米卡星、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、头孢吡肟、头孢他啶、环丙沙星、庆大霉素耐药率30%。结论呼吸道病原菌仍以革兰阴性杆菌为主,细菌耐药现象严重,临床应重视病原菌的监测并结合药敏试验结果合理使用抗菌药物。
[Abstract]:Objective to summarize the distribution and drug resistance of respiratory tract isolates from CHINET from 2005 to 2014. Methods according to the unified scheme, the CHINET member units adopted the unified material, the drug sensitivity test was performed by the disk diffusion method, the automatic instrument method and the E test method, and the results were interpreted according to the CLSI 2014 edition of the United States. The distribution and drug resistance of isolated bacteria in respiratory tract samples were analyzed by WHONET 5.6 software. Results A total of 229,170 strains of bacteria were isolated from respiratory tract samples from 2005 to 2014, of which 78.8 were Gram-negative bacteria and 18.4 were Gram-positive bacteria. The common bacteria were Acinetobacter baumannii 16.7m, Pseudomonas aeruginosa 16.5g, Klebsiella pneumoniae 14.8m, Staphylococcus aureus (Staphylococcus aureus 11.881), Escherichia coli 7.1cm, Staphylococcus maltophilia 5.8m, Enterobacter cloacae 3.8m, Streptococcus pneumoniae 3.7am, Haemophilus influenzae 3.11. The results of drug sensitivity showed that the positive rates of penicillin resistance and PISP of streptococcus pneumoniae in children were 16. 1% and 23. 5, respectively, which were significantly higher than those in adults. The incidence of PRSP in children was significantly higher than that in adults. From 5.4% in 2006 to 21.9% in 2013, 尾 -hemolytic streptococcus was highly sensitive to penicillin and cephalosporins, Streptococcus pneumoniae and Group A streptococcus were resistant to erythromycin, clindamycin 80%, fluoroquinolones, vancomycin, The sensitivity of linazolamide was still high. The detection rate of 尾 -lactamases in Haemophilus influenzae adult strain and child strain was 22.7% and 36.5%, respectively. The sensitivity to azithromycin, cefuroxime and levofloxacin was 90%. The positive rate of vancomycin, teicoplanin, linazolamine resistant strain and methicillin-resistant Staphylococcus aureus MRSAwas 60.8%. Escherichia coli was most sensitive to carbapenes (drug resistance rate 3), followed by cefoperazone-sulbactam, piperacillin-tazobactam (resistance rate 10%). The resistance rate of Klebsiella pneumoniae to imipenem and meropenem increased year by year from 3.1% in 2005 to 10.3% in 2014. The resistant rate of imipenem resistant Klebsiella pneumoniae to tegacyclin was 12.8cm. The resistance rate of Acinetobacter baumannii to minocycline, cefoperazone-sulbactam, imipenem and meropenem increased year by year, and the resistance rate to tegacycline was 6.7%. The resistance rate of Pseudomonas aeruginosa to main antimicrobial agents decreased year by year. The resistance rates to amikacin, piperacillin-tazobactam, cefoperazone-sulbactam, cefepime, ceftazidime, ciprofloxacin and gentamicin were 30. Conclusion Gram-negative bacilli are still the main pathogenic bacteria in respiratory tract, and the drug resistance of bacteria is serious. We should pay attention to the monitoring of pathogenic bacteria and use antibiotics rationally in combination with the results of drug sensitivity test.
【作者单位】：浙江大学医学院附属第一医院传染病诊治国家重点实验室;浙江大学医学院附属邵逸夫医院;上海交通大学医学院附属瑞金医院;北京协和医院;华中科技大学同济医学院附属同济医院;复旦大学附属华山医院;复旦大学附属儿科医院;广州医科大学附属第一医院;北京医院;重庆医科大学附属第一医院;新疆医科大学第一附属医院;上海交通大学附属儿童医院;甘肃省人民医院;安徽医科大学第一附属医院;昆明医科大学第一附属医院;天津医科大学总医院;四川大学华西医院;内蒙古医科大学附属医院;中国医科大学附属第一医院;
【分类号】：R446.5

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