2013年中国CHINET细菌耐药性监测

CHINET 2013 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。方法国内主要地区16所教学医院(14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药物敏感性试验。按CLSI 2013年版标准判断结果。结果 2013年1—12月收集各医院临床分离菌共84 572株,其中革兰阳性菌22 863株,占27.0%,革兰阴性菌61 709株,占73.0%。金黄色葡萄球菌(金葡菌)和凝固酶阴性葡萄球菌(CNS)中甲氧西林耐药株的平均检出率分别为45.2%和73.5%。甲氧西林耐药株(MRSA和MRCNS)对β内酰胺类抗生素和其他测试药物的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。MRSA中有92.2%的菌株对甲氧苄啶-磺胺甲口恶唑敏感;MRCNS中有87.4%的菌株对利福平敏感。葡萄球菌属中均未发现对万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对绝大多数所测试的抗菌药物(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型或vanB型耐药。肺炎链球菌非脑膜炎株成人株和儿童株中青霉素敏感和中介株(PSSP和PISP)所占比例较2012年均略有降低,青霉素耐药肺炎链球菌(PRSP)的检出率有所升高。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株分别平均为54.0%、31.8%和16.5%。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≤7.0%。不动杆菌属(鲍曼不动杆菌占89.2%)对亚胺培南和美罗培南的耐药率分别为62.8%和59.4%。与2012年相比,肺炎克雷伯菌和鲍曼不动杆菌中广泛耐药株的检出率有所降低。结论细菌耐药性仍呈增长趋势,多重耐药和广泛耐药菌株在某些病区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感控措施。

Objective To investigate the susceptibility and resistance of clinical isolates collected from hospitals in several regions of China . Methods Fourteen 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 Systems .Results were analyzed according to CLSI 2013 breakpoints .Results A total of 84 572 clinical isolates were collected from January to December 2013 ,of which gram negative organisms and gram positive cocci accounted for 73 .0% and 27 .0%respectively .Methicillin-resistant strains in S .aureus （MRSA） and coagulase negative Staphylococcus （MRCNS） accounted for an average of 45 .2% and 73 .5% respectively .The resistance rates of methicillin-resistant strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains .However ,92 .2% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole while 87 .4% of MRCNS strains were susceptible to rifampin . No staphylococcal strains were found resistant to vancomycin ,teicoplanin or linezolid .In Enterococcus spp .,the resistance rates of E . f aecalis strains to most tested drugs （except chloramphenicol） were much lower than those of E . f aecium .Some strains of both species were resistant to vancomycin .Vancomycin-resistant strains of E . f aecalis and E . f aecium were mainly VanA type based on their phenotype .Regarding non-meningitis S . pneumoniae strains ,the prevalence of penicillin-susceptible S . pneumoniae and penicillin-intermediate S . pneumoniae strains isolated from both adults and children were lower than those isolated in 2012 ,but the prevalence of penicillin-resistant S .pneumoniae strains increased .The prevalence of ESBLs producing strains was 54 .0% in E .coli ,31 .8% in Klebsiella spp .（K .pneumoniae and K .oxytoca） and 16 .5% in Proteus mirabilis 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 7 .0% of these strains were resistant to carbapenems .About 62 .8% and 59 .4% of Acinetobacter spp .（A .baumannii accounts for 89 .2% ） strains were resistant to imipenem and meropenem ,respectively .Compared with the data of year 2012 , extensively-drug resistant strains in K . pneumoniae and A . baumannii decreased .Conclusions The antibiotic resistance of clinical bacterial isolates is growing in 2013 .The disseminated multi-drug or pan-drug resistant strains in a special region poses a serious threat to clinical practice and implies the importance of strengthening infection control .