2010年中国CHINET细菌耐药性监测

CHINET 2009 surveillance of bacterial resistance in China

目的了解国内主要地区临床分离菌对常用抗菌药物的耐药性。方法国内主要地区14所教学医院(12所综合性医院、2所儿童医院)临床分离菌采用K-B法按统一方案进行细菌药敏试验。按CLSI 2010年版判断结果。结果 2010年1—12月收集各医院临床分离菌共47 850株,其中革兰阳性菌13 568株,占28.4%,革兰阴性菌34 282株,占71.6%。金葡菌和凝固酶阴性葡萄球菌(CNS)中甲氧西林耐药株平均为51.7%和71.6%。葡萄球菌属中甲氧西林耐药株对β内酰胺类抗生素和其他测试药的耐药率显著高于甲氧西林敏感株,MRSA中分别有73.9%、63.2%的菌株对磺胺甲噁唑-甲氧苄啶、磷霉素呈现敏感;MRCNS中分别有87.8%、68.7%的菌株对利福平、磷霉素敏感。未发现万古霉素、替考拉宁和利奈唑胺耐药株,但首次出现少数凝固酶阴性葡萄球菌对利奈唑胺中介株,主要为溶血葡萄球菌。肠球菌属中粪肠球菌对呋喃妥因、磷霉素、氨苄西林的耐药率低于屎肠球菌,两者中均有少数万古霉素耐药株,根据表型推测多数为VanA型耐药。肺炎链球菌非脑膜炎株成人组中PSSP较2009年略有降低,PRSP的检出率有所上升。部分大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中产ESBLs株分别平均为56.2%和43.6%。肠杆菌科细菌中产ESBLs株对所测试抗菌药物的耐药率均比非产ESBLs株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率<6%。不动杆菌属(鲍曼不动杆菌占86.8%)对亚胺培南和美罗培南的耐药率分别为57.1%和58.3%。与2009年相比肺炎克雷伯菌和鲍曼不动杆菌中的泛耐药株数显著增多。结论细菌耐药性仍呈增长趋势,对临床构成严重威胁。加强感染控制措施是当务之急。

Objective To investigate the resistance of clinical isolates from hospitals in several regions of China.Methods Twelve general hospitals and two children s hospitals were involved in this program.Bacterial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method.Results were analyzed according to CLSI 2010 breakpoints.Results A total of 47 850 clinical isolates were collected from January to December 2010,of which gram negative organisms and gram positive cocci accounted for 71.6%and 28.4%respectively.Methicillin-resistant strains accounted for an average of 51.7%in S.aureus（MRSA） and 71.6%in coagulase negative Staphylococcus（MRCNS）.The resistance rates of MR strains toβ-lactams and other antimicrobial agents were much higher than those of MS strains.However, 73.9%and 63.2%of MRSA strains were still susceptible to sulfamethoxazole-trimethoprim and fosfomycin,while 87.8%and 68.7%of MRCNS strains were susceptible to rifampin and fosfomycin.No staphylococcal strains were found resistant to vancomycin, teicoplanin or linezolid.But for the first time,a few coagulase-negative staphylococcal strains were found intermediate to linezolid,mainly Staphylococcus haemolyticus.The resistance rates of E.faecalis strains to most tested drugs including nitrofurantoin, fosfomycin and ampicillin were much lower than those of E.faecium.Some strains of both species were resistant to vancomycin.Vancomycin resistant strains of E.faecalis and E.faecium were mainly Van-A type based on their phenotype. Regarding non-meningitis S.pneumoniae strains,the number of PSSP strains isolated from adults were less than those isolated in 2009,but the prevalence of PRSP strains increased.The prevalence of ESBLs producing strains was 56.2%in E. coli and 43.6%in Klebsiella spp.（K.pneumoniae and K.oxytoca） isolates on average.ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rates.The strains of Enterobacteriaceae were still highly susceptible to carbapenems.Overall less than 6%of these strains were resistant to carbapenems.About 57.1%and 58.3%of Acinetobacter spp.（A.baumannii accounts for 86.8%） strains were resistant to imipenem and meropenem.Compared with the data of year 2009,pan-drug resistant strains in K.pneumoniae and A.baumannii increased significantly.Conclusions The antibiotic resistance of clinical bacterial isolates is growing in 2010.It poses a serious threat to clinical practice and implies the importance of strengthening infection control.