2020年CHINET中国细菌耐药监测

CHINET surveillance of bacterial resistance:results of 2020

目的监测国内主要地区医疗机构临床分离菌对抗菌药物的敏感性。方法对全国52所医院临床分离菌采用纸片扩散法或自动化仪器法按CHINET统一监测方案进行抗菌药物敏感性试验。按2020年CLSI折点标准判断结果。结果收集2020年1—12月上述医院临床分离菌共251 135株,其中革兰阳性菌占28.1%,革兰阴性菌占71.9%。金黄色葡萄球菌、表皮葡萄球菌和其他凝固酶阴性葡萄球菌(除假中间葡萄球菌和施氏葡萄球菌外)中甲氧西林耐药株(MRSA、MRSE和其他MRCNS)的检出率分别为31.0%、81.7%和77.5%,甲氧西林耐药株对绝大多数抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA、MSSE和其他MSCNS)。MRSA中有93.6%菌株对甲氧苄啶-磺胺甲噁唑敏感;MRSE中有89.9%的菌株对利福平敏感;未发现万古霉素耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物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。2020年儿童和成人中分离的非脑膜炎肺炎链球菌中青霉素敏感株(PSSP)(96.7%和95.5%)所占比例较2019年有所上升,青霉素中介和耐药株(PISP和PRSP)的检出率有所下降。除克雷伯菌属对亚胺培南和美罗培南的耐药率分别为21.5%和22.4%外,肠杆菌目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12%。2005—2020年16年的监测显示,肺炎克雷伯菌对亚胺培南和美罗培南的耐药率从2005年的3.0%和2.9%持续上升至2018年的25.0%和26.3%,但从2019年和2020年开始呈连续下降趋势。此外,不动杆菌属对亚胺培南和美罗培南的耐药率分别为68.1%和69.0%,铜绿假单胞菌对上述两药的耐药率分别为23.2%和19.3%。结论临床分离菌对常见抗菌药物的耐药率虽仍呈增长趋势,但如碳青霉烯类耐药的肺炎克雷伯菌和铜绿假单胞菌等多种重要的碳青霉烯类耐药细菌的检出率在多年升高的情况下,近年来呈现连续下降趋势,提示加强细菌耐药监测,结合医院感染预防控制措施,对控制耐药细菌的流行播散是行之有效的。

Objective To investigate the susceptibility and resistance pattern of clinical isolates in hospitals across China.Methods These clinical strains were collected from 52 hospitals.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2020 breakpoints.Results A total of 251135 clinical isolates were collected from January to December 2020,of which gram negative organisms and gram positive cocci accounted for 71.9%and 28.1%,respectively.Methicillin-resistant strains in S.aureus(MRSA),S epidermidis and other Staphylococcus spp.(except S.pseudintermedius and S.schleiferi)accounted for 31.0%,81.7%,and 77.5%,respectively.The resistance rates of MR strains to most of other antimicrobial agents were much higher than those of MS strains.However,93.6%of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 89.9%of MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin.E.faecalis strains showed much lower resistance rates to most of the drugs tested than E.faecium.A few strains of both species were resistant to vancomycin.Among the S.pneumoniae strains isolated from children and adults,the prevalence of PSSP(96.7%and 95.5%,respectively)strains were higher than those isolated in 2019.The prevalence of PISP and PRSP were lower than those isolated in 2019.The strains of Enterobacteriaceae were still highly susceptible to carbapenems,Overall,less than 12%of these strains(except Klebsiella)were resistant to carbapenems.The percentage of K.pneumoniae strains resistant to imipenem and meropenem increased from 3.0%to 25.0%and from 2.9%to 26.3%,respectively from 2005 to 2018.However,the prevalence of imipenem-and meropenem-resistant Klebsiella strains decreased in 2019 and 2020.About 68.1%and 69.0%of Acinetobacter spp.strains were resistant to imipenem and meropenem,respectively.The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 23.2%and 19.3%,respectively.Conclusions The prevalence of carbapenem-resistant K.pneumoniae and P.aeruginosa decreased even though bacterial resistance to commonly used antibiotics is still on the rise.It is necessary to strengthen the surveillance of bacterial resistance and the measures for control of infectious diseases.