全国细菌耐药监测网2014—2019年细菌耐药性监测报告

Antimicrobial resistance of bacteria:surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019

目的了解2014—2019年全国临床标本常见病原菌分布及耐药性,为临床抗菌药物合理应用,以及政府及时掌握全国细菌耐药形势,制定和评价抗菌药物临床应用管理政策提供科学依据。方法按照全国细菌耐药监测网(CARSS)技术方案,利用WHONET 5.6软件对2014—2019年CARSS上报的分离菌耐药性进行分析。结果2014—2019年革兰阳性菌分离居前5位的是金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、肺炎链球菌和屎肠球菌,革兰阴性菌分离居前5位的为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和阴沟肠杆菌。6年来,耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率有所下降(分别从36.0%、79.8%降至30.2%、75.4%)。耐万古霉素粪肠球菌和屎肠球菌检出率均呈下降趋势(分别从0.8%、2.9%降至0.2%、1.1%)。耐青霉素肺炎链球菌(PRSP)检出率从4.3%降至1.6%。耐亚胺培南铜绿假单胞菌检出率变化不大(18.2%~21.0%)。鲍曼不动杆菌对各抗菌药物的耐药率大多数高于50%。大肠埃希菌和肺炎克雷伯菌对头孢噻肟的耐药率逐渐下降,大肠埃希菌对亚胺培南的耐药率变化不大,且均低于1.5%。肺炎克雷伯对亚胺培南耐药率从4.8%升至10.5%。流感嗜血杆菌对各抗菌药物的耐药率均有所上升,其中对氨苄西林耐药率从48.1%升至69.0%。结论MRSA、MRCNS以及耐万古霉素肠球菌的检出率有所下降。耐亚胺培南肺炎克雷伯菌检出率呈上升趋势,鲍曼不动杆菌对各抗菌药物的耐药性严重,流感嗜血杆菌对各抗菌药物的耐药率均有所上升。应继续加强抗菌药物合理应用的管理及医院感染防控,做好耐药监测工作。

Objective To understand the distribution and antimicrobial resistance of common pathogens in clinical specimens in China from 2014 to 2019,provide scientific basis for the rational clinical antimicrobial use as well as the formulation and evaluation of management policies for antimicrobial clinical use.Methods According to China Antimicrobial Resistance Surveillance System(CARSS)technical program,antimicrobial resistance of all isolated bacteria reported by CARSS in 2014-2019 were analyzed with WHONET 5.6 software.Results From 2014 to 2019,the top 5 isolated Gram-positive bacteria were Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecalis,Streptococcus pneumoniae,and Enterococcus faecium,the top 5 isolated Gram-negative bacteria were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii and Enterobacter cloacae.In the past 6 years,isolation rates of methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant coagulase negative Staphylococcus(MRCNS)decreased from 36.0%to 30.2%and 79.8%to 75.4%respectively.Isolation rates of vancomycin-resistant Enterococcus faecalis and Enterococcus faecium showed a downward trend(from 0.8%to 0.2%and from 2.9%to 1.1%respectively).Isolation rate of penicillin-resistant Streptococcus pneumoniae(PRSP)also decreased from 4.3%to 1.6%.Isolation rates of imipenem-resistant Pseudomonas aeru-ginosa changed little(18.2%-21.0%).Antimicrobial resistance rate of Acinetobacter baumannii was more than 50%.Resistance rates of Escherichia coli and Klebsiella pneumoniae to cefotaxime decreased gradually,resistance rates of Escherichia coli to imipenem didn’t change much,and were all lower than 1.5%.Resistance rate of Klebsiella pneumoniae to imipenem increased from 4.8%to 10.5%.Resistance rates of Haemophilus influenzae to all kinds of antimicrobial agents increased,resistance rate to ampicillin increased from 48.1%to 69.0%.Conclusion Isolation rates of MRSA,MRCNS and vancomycin-resistant Enterococcus decreased.Isolation rate of imipenem-resistant Klebsiella pneumoniae showed an upward trend,resistance of Acinetobacter baumannii to all kinds of antimicrobial agents is serious,resistance rates of Haemophilus influenzae to all kinds of antimicrobial agents increased.Management of rational use of antimicrobial agents as well as prevention and control of healthcare-associa-ted infection should be strengthened continuously,antimicrobial resistance surveillance should be conducted well.