2018年内蒙古包头市细菌耐药性监测

Surveillance of antimicrobial resistance in the clinical isolates from hospitals in Baotou, Inner Mongolia during 2018

目的了解2018年内蒙古包头市11所参加全国细菌耐药监测网医院临床分离株的构成及耐药情况,为本地区临床合理化用药提供理论依据。方法各成员医院按监测方案,采用纸片扩散法或自动化仪器检测法进行药敏试验,按美国临床实验室标准化研究协会(CLSI)2017年版标准判读药敏结果,采用WHONET 5.6软件进行数据分析。结果共收集上述医院非重复临床分离菌7773株,其中革兰阳性菌2138株,占27.5%,革兰阴性菌5635株,占72.5%。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)的平均检出率分别为12.2%和66.9%,MRSA和MRCNS对大多数抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS),未发现利奈唑胺、万古霉素和替考拉宁耐药菌株。屎肠球菌对大多数抗菌药物的耐药率均显著高于粪肠球菌,粪肠球菌中发现有3株利奈唑胺、1株万古霉素和1株替考拉宁耐药菌株。非脑脊液标本分离的肺炎链球菌对青霉素的耐药率为2.0%。大肠埃希菌和克雷伯菌属中产ESBL菌株的平均检出率分别为48.3%和20.6%,产ESBL菌株对所测抗菌药物的耐药率均高于非产ESBL菌株。肠杆菌科细菌中CRE的检出率为1.2%,CRKP菌株对阿米卡星的耐药率为64.3%。铜绿假单胞菌对碳青霉烯类、氨基糖苷类、喹诺酮类、头孢他啶、头孢吡肟、头孢哌酮/舒巴坦和哌拉西林/三唑巴坦的耐药率均低于15.0%。不动杆菌属对包括碳青霉烯类在内的大多数抗菌药物的耐药率超过38.0%,其中亚胺培南和美罗培南的耐药率分别为42.3%和43.5%。结论我市细菌耐药情况较全国水平低,但仍呈缓慢增长趋势,应继续做好细菌耐药性监测工作,加强抗菌药物临床应用管理措施,以合理化使用抗菌药物。

Objective To investigate the composition and antimicrobial resistance profile of clinical isolates from 11 hospitals taking part in the China Antimicrobial Resistance Surveillance System(CARSS)in Baotou,Inner Mongolia during 2018 for providing a theoretical basis for clinical rational antibiotic use.Methods The susceptibilities of all clinical isolates to antimicrobial agents were determined by the Kirby-Bauer method or automated systems according to a unified protocol.The data were analyzed using the WHONET 5.6 software according to CLSI 2017 breakpoints.Results A total of 7,773 non-repetitive clinical isolates were collected from the above hospitals,of which Gram-positive bacterial and Gram-negative bacterial accounted for 27.5%and 72.5%,respectively.The prevalence of methicillin-resistant strains was 12.2%in Staphylococcus aureus and 66.9%in coagulase-negative Staphylococcus on average.MR strains showed much higher resistance rates to most commonly used antimicrobial agents than MS strains.No linezolid,vancomycin and teicoplanin resistant staphylococcal strains were found.E.faecium strains showed much higher resistance rates to most of the antimicrobial agents tested than E.faecalis.Three strains resistant to linezolid,one strain to vancomycin and one strain to teicoplanin were identified.According to non-CNS,2.0%penicillin resistant S.pneumoniae strains were found.The prevalence of ESBLs-producing strains was 48.3%in E.coli and 20.6%in Klebsiella spp.ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBL-producing strains in term of antibiotic resistance rates.The prevalence of CRE was 1.2%.The resistance rate of CRKP to amikacin was 64.3%.The resistance rates of P.aeruginosa to carbapenem,aminoglycosides,quinolones,ceftazidime,cefepime,cefoperazone/sulbactam,and piperacillin/tazobactamand were all below 15.0%.The resistance rates of Acinetobacter spp.to most surveillance antimicrobial agents including carbapenem were above 38.0%,and to imipenem and meropenem were 42.3%and 43.5%,respectively.Conclusion Although bacterial resistance in our city compared with the national level is low,but it is still on the rise slowly.We should continue to monitor antimicrobial resistance and strengthen clinical use of antibiotic management measures to rationally use antibiotics.