2005—2014年CHINET儿童患者分离革兰阴性菌耐药性监测

发布时间：2018-06-26 01:45

本文选题：革兰阴性杆菌 + 碳青霉烯类耐药肠杆菌科细菌　；参考：《中国感染与化疗杂志》2016年04期

【摘要】：目的了解2005-2014年中国主要地区儿童患者中革兰阴性分离菌对常用抗菌药物的耐药性。方法中国主要地区19所教学医院(17所综合医院和2所儿童医院)分离自儿童患者的革兰阴性菌,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试验。按CLSI 2014版标准判断结果。结果2005-2014年收集各医院儿童患者革兰阴性菌63 294株,其中肠杆菌科细菌43 109株,占68.1%,不发酵糖革兰阴性杆菌13 994株,占22.1%。儿童患者分离革兰阴性菌的检出率呈下降趋势:2006年为14.4%,2014年为12.1%。肠杆菌科细菌对头孢唑林、头孢呋辛、头孢噻肟、头孢他啶及头孢吡肟平均耐药率较高,对碳青霉烯类、氨基糖苷类和酶抑制剂复合制剂平均耐药率均10%。大肠埃希菌和克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)平均产ESBL率分别为68.4%和62.2%。肺炎克雷伯菌对碳青霉烯类抗生素、两种酶抑制剂复合制剂及头孢菌素类耐药率明显上升。变形杆菌属、枸橼酸杆菌属及沙雷菌属对碳青霉烯类耐药率有下降趋势。鲍曼不动杆菌对亚胺培南和美罗培南耐药率也呈上升趋势。铜绿假单胞菌对所测试的抗菌药物耐药率有下降趋势。嗜麦芽窄食单胞菌及伯克霍尔德菌属检出率不断增多但对所测试抗菌药物的耐药率变化不大。流感嗜血杆菌对氨苄西林耐药率及产β内酰胺酶率均在30%~45%。2014年碳青霉烯类耐药肺炎克雷伯菌检出率为15.9%。2005-2014年均有广泛耐药(XDR)菌检出,XDR铜绿假单胞菌检出率在0.2%~2.0%;XDR鲍曼不动杆菌和XDR肺炎克雷伯菌检出率分别在0.9%~24.6%和0~4.2%。结论分离于儿童患者革兰阴性菌的耐药性总体呈上升趋势,碳青霉烯类耐药肠杆菌科细菌和XDR的检出率不断增多是抗感染治疗的一大挑战,应引起临床关注。
[Abstract]:Objective to investigate the antimicrobial resistance of Gram-negative isolates to common antimicrobial agents in children in major areas of China from 2005 to 2014. Methods Gram-negative bacteria isolated from 19 teaching hospitals (17 general hospitals and 2 children's hospitals) in major areas of China were tested for bacterial drug sensitivity by disk diffusion method or automatic instrument method according to the unified scheme. Judge the results according to CLSI version 2014 standard. Results 63,294 strains of Gram-negative bacteria were collected from children in various hospitals from 2005 to 2014, including 43,109 strains of Enterobacteriaceae (68.1%) and 13 994 strains of non-fermentative gram-negative bacilli (22.1%). The positive rate of Gram-negative bacteria isolated from children decreased: 14.4in 2006 and 12.1 in 2014. The average resistance rate of Enterobacteriaceae to cefazolin, cefuroxime, cefotaxime, ceftazidime and cefepime was higher, and the average resistance rate to carbapenems, aminoglycosides and enzyme inhibitors was 10%. The average ESBL production rates of Escherichia coli and Klebsiella (Klebsiella pneumoniae and Klebsiella acidogenic) were 68.4% and 62.2%, respectively. The resistance rate of Klebsiella pneumoniae to carbapenems, two enzyme inhibitors and cephalosporins increased significantly. Proteus, Citrate and Shareh have decreased resistance to carbapenes. The resistance of Acinetobacter baumannii to imipenem and meropenem also increased. The resistance rate of Pseudomonas aeruginosa to antimicrobial agents tested showed a decreasing trend. The detection rate of Stenotrophomonas maltophilia and Bachelia was increasing, but the rate of resistance to antimicrobial agents tested had little change. Haemophilus influenzae resistance rate to ampicillin and 尾 lactamase production rate were 300.45.2014 the detection rate of Klebsiella pneumoniae resistant to carbapenem was 15.910%. 2005-2014, XDR Pseudomonas aeruginosa was detected in 0.22.00.22.0XDR Baumann did not. The detectable rates of Acinetobacter pneumoniae and Klebsiella pneumoniae were 0.96% and 0.4.2%, respectively. Conclusion the drug resistance of Gram-negative bacteria isolated from children is on the rise. The increasing detection rate of carbapenem resistant Enterobacteriaceae and XDR is a major challenge of anti-infection therapy and should be paid attention to clinically.
【作者单位】：上海市儿童医院上海交通大学附属儿童医院检验科;复旦大学附属儿科医院;华中科技大学同济医学院附属同济医院;北京协和医院;新疆医科大学第一附属医院;甘肃省人民医院;昆明医科大学第一附属医院;安徽医科大学第一附属医院;广州医科大学附属第一医院;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;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;浙江大学附属第一医院;重庆医科大学附属第一医院;北京医院;浙江大学医学院附属邵逸夫医院;
【分类号】：R446.5

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