2012年中国CHINET细菌耐药性监测

2012 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物的敏感性和耐药性。方法对国内主要地区(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 2012年版标准判断结果。结果 2012年1—12月收集各医院临床分离菌共72 397株,其中革兰阳性菌20 354株,占28.1%,革兰阴性菌52 043,占71.9%。金葡菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)的检出率平均分别为47.9%和77.1%。甲氧西林耐药株对β内酰胺类抗生素和其他测试抗菌药物的耐药率显著高于甲氧西林敏感株。MRSA中87.0%菌株对甲氧苄啶-磺胺甲口恶唑敏感;MRCNS中89.1%菌株对利福平敏感,发现0.4%菌株对替考拉宁耐药。葡萄球菌属细菌中未发现对万古霉素、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物(除氯霉素外)的耐药率均显著低于屎肠球菌。两者中均检出少数万古霉素耐药株,根据表型推测多数为VanA型耐药;此外两者中均有少数替考拉宁和利奈唑胺耐药株。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中产ESBLs株平均分别为55.3%、33.9%和20.7%。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率4.4%～6.3%。不动杆菌属细菌(鲍曼不动杆菌占89.6%)对亚胺培南和美罗培南耐药率分别为57.0%和61.0%。肠杆菌科细菌中仍有少数碳青霉烯类抗生素耐药株,尤以肺炎克雷伯菌为多。结论细菌耐药性仍是临床重要问题,尤其耐碳青霉烯类肠杆菌科细菌应引起高度关注。

Objective To investigate the susceptibility and resistance of clinical bacterial isolates from hospitals in sev- eral major regions of China. Methods Thirteen general hospi- tals 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 automa- ted systems. Results were analyzed according to the breakpoints of CLSI 2012. Results A total of 72 397 clinical isolates were collected from January through December 2012, of which Gram negative organisms and Gram positive cocci accounted for 71.9% （52 043/72 397） and 28.1% （20 354/72 397） respectively. The average prevalence of methicillin-resistant strains in S. aureus （MRSA） and coagulase-negative Staphylococcus （MRCNS） was 47.9% and 77.1%, respectively. The resistance rates of MR strains to beta-lactams and other antimicrobial agents were much higher than those of MS strains. However, nearly 87.0% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 89.1% of MRCNS strains were suscep- tible to rifampin. No stahylococcal strain was found resistant to vancomycin, teicoplanin or linezdid. Nearly 0.4% of the MRC- NS strains were found resistant to teicoplanin. In Enterococcus spp. , the resistance rates of E. fecalis strains to most antimi- crobial agents tested （except chloramphenieol） were much lower than those of 13. faeciurn. Some strains of both species were resistant to vancomycin, most of which were VanA type based on their phenotype. Some strains resistant to teicoplanin or lin- ezolid were identified in both species. The prevalence of ESBLs producing strains was 55.3% in E. coli, 33.9% in Klebsiella spp. （K. pneumoniae and K. oxytoca） and 20. 7% in Proteus mirabilis on average. ESBLs producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains to all the antimicrobial agents tested. Enterobacteriaceae strains were still highly susceptible to the three carbapenems tested, the overall resistance rates being 4.4%-6.3 %. The resistance rates of Acinetobacter spp. （A. baurnannii accounted for 89.6 % ） to imipenem and meropenem were up to 57.0 % and 61.0 %, respectively. Some carbapenem resistant strains were found in various Enterobacteriaceae spp. , especially in K. pneumoniae. Conclusions Bacterial resistance is still an important problem in clinical setting in China, especially the carbapenem resistant Enterobacteriaceae, which is of great concern.