2011年中国CHINET细菌耐药性监测

2011 CHINET 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的敏感性和耐药性。方法国内主要地区15所教学医院(13所综合性医院、2所儿童医院)临床分离菌采用纸片扩散法或自动化仪器法按统一方案进行细菌药敏试验。按CLSI 2011年版判断结果。结果 2011年1 12月收集各医院临床分离菌共59 287株,其中革兰阳性菌16 872株,占28.5%,革兰阴性菌42 415株,占71.5%。金葡菌(SA)和凝固酶阴性葡萄球菌(CNS)中甲氧西林耐药株的检出率平均分别为50.6%和74.6%。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中有73.3%的菌株对甲氧苄啶磺胺甲噁唑敏感;MRCNS中有88.2%的菌株对利福平敏感。未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属细菌中粪肠球菌对所测试的抗菌药(氯霉素除外)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,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株和儿童株中PSSP所占比例较2010年均略有升高,PRSP的检出率均有所下降。大肠埃希菌、克雷伯菌属细菌(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中产ESBLs株分别平均为50.7%、38.5%和13.8%。肠杆菌科细菌中产ESBLs株对测试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4%～6%。不动杆菌属细菌(鲍曼不动杆菌占88.6%)对亚胺培南和美罗培南的耐药率分别为60.4%和61.4%。肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中仍有少数泛耐药株。结论细菌耐药性仍呈增长趋势,多重耐药和泛耐药菌株在某些科室内的流行播散对临床构成严重威胁,应进行流行病学调查并采取有效的控制措施。

Objective To investigate the susceptibility and resistance of clinical bacterial isolates from hospitals in sev- eral regions of China. Methods Thirteen general hospitals and two children＇s hospitals were involved in this program.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated Sys- tems. Results were analyzed according to the breakpoints of CLSI 2011. Results A total of 59 287 clinical isolates were collect- ed from January to December 2011, of which gram negative organisms and gram positive cocci accounted for 71.50% （42 415/ 59 287） and 28.5% （16 872/59 287） respectively. The average prevalence of methicillin-resistant strains in S. aureus （MR- SA） and coagulase negative staphylococcus （MRCNS） was 50.6% and 74.6% respectively. The resistance rates of MR strains to β-1actams and other antimicrobial agents were much higher than those of MS strains. However, nearly 73.3% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 88.2 % of MRCNS strains were susceptible to rifampin. No staphylococcal strain was found resistant to vancomycin, teicoplanin or linezolid. In Enterococcus spp. , the resistance rates of E. faecalis strains to most tested drugs （except chloramphenicol） were much lower than those of E. faecium. Some strains of both species were resistant to vancomycin. Vancomycin resistant E. faecalis and E. faecium strains were mainly VanA type based on their phenotype. As for non-meningitis S. pneumoniae strains, the prevalence of PSSP strains isolated from both a- dults and children were higher than those isolated in 2010, but the prevalence of PRSP strains decreased. The prevalence of ES- BLs producing strains was 50.7% in E. coli and 38.50% in Klebsiella spp. （K. pneumoniae and K. oxytoca） and 13.8% in Proteus mirabilis isolates on average. ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-produ- cing strains in terms of antibiotic resistance rate. The Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall less than 6.1% of these strains were resistant to carbapenems. About 60.4% and 61.4% of Acinetobacter spp. （A. baumannii accounts for 88.6%） strains were resistant to imipenem and meropenem respectively. Compared with the data of year 2010, pan-drug resistant strains in K. pneumoniae and A. baurnannii decreased. Conclusions The antibiotic resistance of clinical bacterial isolates is growing in 2011. The spread of multi-drug or pan-drug resistant strains in a specific region poses a serious threat to clinical practice and implies the importance of strengthening infection control.