2016年中国CHINET细菌耐药性监测

发布时间：2018-05-21 04:35

本文选题：细菌耐药性监测 + 药物敏感性试验　；参考：《中国感染与化疗杂志》2017年05期

【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。方法对国内主要地区30所教学医院(26所综合性医院、4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抗菌药物敏感性试验。按CLSI 2016版判断结果。结果收集2016年1-12月上述医院临床分离菌共153 059株,其中革兰阳性菌43 462株,占28.4%,革兰阴性菌109 597株,占71.6%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株的平均检出率分别为38.4%和77.6%。甲氧西林耐药株(MRSA和MRCNS)对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%菌株对甲氧苄啶-磺胺甲唑敏感;MRCNS中有86.5%菌株对利福平敏感;未发现万古霉素和替考拉宁耐药菌株。肠球菌属中粪肠球菌对多数测试抗菌药物(氯霉素除外)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,经表型或基因型检测结果显示主要为Van A型、Van B型或Van M型耐药。儿童肺炎链球菌非脑膜炎分离株中青霉素敏感和中介(PSSP和PISP)株所占比例较2015年有所上升,青霉素耐药(PRSP)株的检出率有所下降;成人分离株中PISP和PRSP均有所下降。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率分别平均为45.2%、25.2%和16.5%,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,多数菌属的耐药率低于10%。不动杆菌属(鲍曼不动杆菌占90.6%)对亚胺培南和美罗培南的耐药率分别为68.6%和71.4%。与2015年耐药率数据相比,铜绿假单胞菌中广泛耐药株的检出率有所上升。结论临床分离菌对常用抗菌药物的耐药率仍呈增长趋势,应加强医院感染防控措施和抗菌药物临床应用管理措施,继续做好细菌耐药性监测工作。
[Abstract]:Objective to understand the sensitivity and resistance of clinical isolates to commonly used antibiotics in the main areas of China. Methods the clinical isolates of clinical isolates from 30 teaching hospitals (26 comprehensive hospitals and 4 children's hospitals) in the main areas of China were tested by the paper diffusion method or automatic instrument method according to the unified scheme, and the CLSI 2016 version was found. Results 153059 strains of clinical isolates were collected in 1-12 months of 2016, including 43462 Gram-positive bacteria, 28.4% and 109597 Gram-negative strains, which accounted for 38.4% and 77.6%. methoxicillin resistant strains of 71.6%. Staphylococcus aureus and coagulase negative staphylococcus (MRSA and MR), respectively. CNS) the resistance rate of most of the test drugs was significantly higher than that of methicillin sensitive strain (MSSA and MSCNS). 92.3% strains were sensitive to trimethoprim and sulfamethazol in.MRSA; 86.5% strains in MRCNS were sensitive to rifampicin; no vancomycin and teicoplanin resistant strains were found. The rate of drug resistance was significantly lower than that of Enterococcus faecium. There were a few vancomycin resistant strains in both. The results of phenotypic or genotyping showed that Van A, Van B or Van M were resistant. The proportion of penicillin sensitive and intermediate (PSSP and PISP) in the isolates of Streptococcus pneumoniae isolated from children was higher than that in 2015. The detection rate of mycophenolate resistant (PRSP) strain decreased, and both PISP and PRSP decreased in adult isolates. The average ESBL rates of Escherichia coli and Klebsiella (Klebsiella pneumoniae and Klebsiella pneumoniae) and Proteus mirabilis were 45.2%, 25.2% and 16.5% respectively. The resistance rate of ESBL strains to test drugs was higher than that of non producing ESBL strains. The bacteria were highly sensitive to carbapenems, and the resistance rate of most genera was lower than that of 10%. (Acinetobacter 10%. (90.6%). The resistance rate of imipenem to imipenem and meropenem was 68.6% and 71.4%., respectively, compared with the drug resistance rate in 2015. The detection rate of the widely resistant strains in Pseudomonas aeruginosa was increased. The resistance rate of the bed isolation bacteria to the commonly used antibiotics is still increasing. The prevention and control measures of hospital infection and the management measures for the clinical application of antibiotics should be strengthened, and the monitoring of bacterial resistance should be continued.
【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抗生素研究所检验科;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上海市儿童医院;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;哈尔滨医科大学附属第一医院;中南大学湘雅医院;山东省立医院;福建省晋江医院;吉林大学中日联谊医院;四川省人民医院;河南省人民医院;陕西省人民医院;江西省儿童医院;山西省儿童医院;
【分类号】：R446.5

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