2013年全国13所教学医院院内血流感染及院内获得性肺炎和院内获得性腹腔感染常见病原菌分布和耐药性研究

Analysis of pathogen spectrum and resistance of clinical common organisms causing bloodstream infections, hospital-acquired pneumonia and intra-abdominal infections from thirteen teaching hospitals in 2013

目的 明确2013年在我国引起院内感染的主要病原菌的病原谱及对抗菌药物的敏感性.方法 收集来自全国13家教学医院的引起院内血流感染（BSI）、院内获得性肺炎（HAP）和院内获得性腹腔感染（IAI）的病原菌,使用琼脂稀释法测定菌株的最低抑菌浓度（MIC）,判定标准使用美国临床和实验室标准协会（CLSI） M100-S23的规定.结果 共收集BSI病例1 022例、HAP病例683例和IAI病例674例.大肠埃希菌和肺炎克雷伯菌是引起BSI和IAI的最主要的致病菌,而鲍曼不动杆菌和铜绿假单胞菌是引起HAP的最主要致病菌.替加环素、亚胺培南和美罗培南对肠杆菌科细菌表现出很高的抗菌活性,敏感率分别为95.6％、94.2％和95.2％.肠杆菌科细菌对头孢菌素和氟喹诺酮类耐药率较高,分别为52.3％和38.9％,但对β-内酰胺类联合酶抑制剂敏感性较高.在肠杆菌细菌中超广谱β内酰胺酶（ESBLs）的发生率为30.5％,碳青霉烯耐药的肠杆菌科细菌（CRE）的发生率为4.3％.鲍曼不动杆菌除对替加环素（90.5％）和多粘菌素（100％）表现出较高的敏感性,对其他抗菌药物均表现出较高的耐药率.有76.6％的鲍曼不动杆菌对碳青霉烯耐药.阿米卡星、环丙沙星、头孢吡肟和哌拉西林/他唑巴坦对铜绿假单胞菌的抗菌效果较好,敏感率分别为88.5％、77.6％、72.7％和64.5％.铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为42.1％和32.2％.166株金黄色葡萄球菌对替加环素、利奈唑胺、达托霉素和糖肽类抗生素都表现为敏感.甲氧西林耐药的金黄色葡萄球菌（MRSA）在金黄色葡萄球菌中的比例为46.9％.MRSA在IAI中占金黄色葡萄球菌的比例为55.2％,在HAP中为54.4％,均高于其在BSI中的比例（35.0％）.未发现对替加环素、利奈唑胺和达托霉素耐药的肠球菌.万古霉素耐药的肠球菌（VRE）只在屎肠球菌中发现,占屎肠球菌的1.9％.结论 大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌是院内感染的最常见病原菌.替加环素对于引起院内感染的致病菌有较强的抗菌活性.对产ESBLs的肠杆菌科细菌对β内酰胺联合酶抑制剂和碳青霉烯类药物的敏感性高.万古霉素、替考拉宁和利奈唑胺对葡萄球菌和肠球菌作用效果好.

Objective To investigate the spectrum and antimicrobial resistance of major pathogensthat causing nosocomial infections in China,2013.Methods Nosocomial cases as well as pathogens causing bloodstream infections （BSI）,hospital-acquired pneumonia （HAP） and intra-abdominal infections （IAI） from 13 teaching hospital around China were collected.The minimum inhibitory concentrations （MICs） were determined by the agar dilution method.The CLSI M100-S23 criteria were used for interpretation.Results Of all cases,1 022 cases were from BSI,683 from HAP and 674 from IAI.Escherichia coli and Klebsiella pneumoniae were the most prevalent pathogens causing BSI and IAI while Acinetobacter baumanii （34.6%） and Pseudomonas aeruginosa were dominated in HAP.Tigecycline,imipenem and meropenem exhibited high potency against Enterobacteriaceae and the susceptibilities rates were 95.6%,94.2% and 95.2% respectively.Enterobacteriaceae demonstrated high resistance against cephalosporins （52.3%） and fluoroquinolones （38.9%） but were susceptible to β-lactam ＋ inhibitor.Of all the Enterobacteriaceae,30.5% were ESBLs positive and 4.3% were carbapenem resistant.Acinetobacter baumanii showed low susceptibilities to the microbial agents except for tigecycline （90.5%） and colistin （100%）.The rate of carbapenem resistant Acinetobacter baumanii was 76.6%.Amikacin,ciprofloxacin,cefepime and piperacillin/tazobactam showed high antibacterial activity against Pseudomonas aeruginosa with susceptible rate 88.5%,77.6%,72.7% and 64.5% respectively.The resistant rate to imipenem and meropenem were 42.1% and 32.2%.All Staphylococcus aureus （166 strains） were susceptible to tigecycline,linezolid,daptomycin and glycopeptides.MRSA accounted for 46.9% of all the Staphylococcus aureus.The prevalence of MRSA in IAI （55.2%） and HAP （54.4%） were higher that that in BSI （35.0%）.No Enterococcus strains were found resistant to tigecycline,linezolid and daptomycin.VRE was found in Enterococcus faecium,accounting for 1.9% of all Enterococcus faecium strains.Conclusions Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa are the most common pathogens causing nosocomial infections.Nosocomial pathogens showed high susceptibilities against tigecycline.For ESBLs-producing Enterobacteriaceae strains,β-lactam ＋ Inhibitor show high antibacterial activities.Vancomycin,teicoplanin and linezolid exhibit high potency to Staphylococcus aureus and Enterococcus.