2009年中国CHINET大肠埃希菌和克雷伯菌属细菌耐药性监测

CHINET 2009 surveillance of antimicrobial resistance in E. coli and Klebsiella spp in China

目的了解2009年中国CHINET所属14所医院临床分离的大肠埃希菌和克雷伯菌属的耐药情况。方法采用纸片扩散法(K-B法)对临床分离株作药敏试验。结果共收集CHINET细菌耐药性监测网14所医院分离的大肠埃希菌7992株,肺炎克雷伯菌4556株和产酸克雷伯菌377株。其中儿童患者(0～14岁)来源的大肠埃希菌和克雷伯菌属分别占21.3%(1700/7992)和18.5%(915/4933)。大肠埃希菌和克雷伯菌属产ESBLs株检出率分别为56.5%(33.3%～78.5%)和41.4%(21.7%～70.8%)。各医院ESBLs检出率存在一定差异。药敏试验结果显示,大肠埃希菌对亚胺培南、美罗培南和厄他培南等3种碳青霉烯类抗生素的耐药率均小于1%,对头孢哌酮-舒巴坦和哌拉西林-他唑巴坦的耐药率低于6%。肺炎克雷伯菌对3种碳青霉烯类抗生素耐药率介于2.9%～5.2%,对头孢哌酮-舒巴坦和哌拉西林-他唑巴坦的耐药率分别为10.8%和15.1%。产ESBLs菌对上述5种药物的耐药率也低于25%。50%以上的产ESBLs株对庆大霉素和环丙沙星耐药。有10所医院分离出对碳青霉烯类抗生素不敏感菌株,其中肺炎克雷伯菌132株,大肠埃希菌20株。83株肺炎克雷伯菌和5株大肠埃希菌为泛耐药株,主要集中于复旦大学附属华山医院(共73株)。结论大肠埃希菌和克雷伯菌属对碳青霉烯类抗生素、头孢哌酮-舒巴坦和哌拉西林-他唑巴坦仍保持高度敏感性。与2007年细菌耐药性监测资料相比,对碳青霉烯类不敏感菌株分离率上升明显,尤以肺炎克雷伯菌为甚。

Objective To investigate the antimicrobial resistance of E.coli and K.pneumoniae strains isolated from 14 hospitals in China CHINET program during 2009.Methods Disc diffusion test(Kirby-Bauer method)was employed to study the antimicrobial resistance.WHONET 5.4 was applied for data analysis.Results A total of 12 548 clinical isolates collected during 2009 were analyzed;including 7 992 strains of E.coli,and 4 556 strains of K.pneumoniae.About 21.3%(1 700/7 992)of E.coli and 19.0%(865/4 556)of K.pneumoniae were collected from pediatric patients.The total prevalence of ESBLs-producing strains in E.coli and Klebsiella spp.isolates was 56.5% and 42.5%,respectively.The prevalence of ESBLs-producing strains varied with hospital,ranging from 33.3% to 78.5% in E.coli,from 19.4% to 72.4% in K.pneumoniae.E.coli still showed the lowest resistance(<1%)to imipenem,meropenem or ertapenem,followed by cefoperazone-sulbactam and piperacillin-tazobactam,the resistance rate to which was lower than 6%.K.pneumoniae also showed the lowest resistance to the 3 carbapenem agents.The resistance rates ranged from 2.9% to 5.2%,followed by cefoperazone-sulbactam(10.8%)and piperacillin-tazobactam(15.1%).Less than 25% of ESBLs-producing strains of E.coli and K.pneumoniae were found resistant to the 3 carbapenem agents,cefoperazone-sulbactam or piperacillin-tazobactam.Up to 50% ESBLs-producing strains were resistant to both gentamicin and ciprofloxacin.A total of 132 strains of K.pneumoniae and 20 strains of E.coli,isolated from 10 hospitals,were not susceptible to both imipenem and meropenem.And 103 of the 132 strains of K.pneumoniae and 8 of the 20 strains of E.coli were resistant to all the antimicrobial agents tested.Such pan-resistant strains were mainly found in Shanghai Huashan Hospital.Conclusions Compared with the CHINET data in 2008,carbapenems,cefoperazone-sulbactam and piperacillin-tazobactam are still highly active against Enterobacteriaceae.It is worthy to note that the prevalence of the strains non-susceptible to carbapenem is increasing rapidly,especially vK.pneumoniae.