2006—2011年Mohnarin血流感染的病原菌分布及耐药性变迁的荟萃分析

Meta-analysis of changes in bacterial distribution and drug resistance of bloodstream infections

目的了解中国2006—2011年Mohnar in监测中血流感染的病原菌分布及耐药性变迁。方法采用荟萃分析方法,将分离的主要病原菌对临床常用的几种重要抗生素的耐药率历年来的变化进行综合分析,并采用卡方检验对各种抗菌药物耐药率变化情况进行趋势分析。结果共检索到符合要求的文献5篇。历年分离最多的为凝固酶阴性葡萄球菌,其次为大肠埃希菌、克雷伯菌属、金黄色葡萄球菌和肠球菌占据第3到第5,在各年份中稍有变化。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率维持在50%左右,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率从2006年起呈现逐渐下降趋势;未发现万古霉素和利奈唑胺耐药株。肠球菌属利奈唑胺耐药株的检出数量呈上升趋势,2011年检出7株利奈唑胺耐药屎肠球菌和1株利奈唑胺耐药的粪肠球菌。大肠埃希菌和克雷伯菌属ESBLs的检出率在2010年骤然升高,分别达70.2%和53.3%。2006—2011年,碳青霉烯类耐药的大肠埃希菌和肺炎克雷伯菌呈上升趋势,历年差异有统计学意义(P<0.001);到2011年,大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率分别达4.3%和8.3%。不动杆菌属和铜绿假单胞菌是糖类非发酵菌中分离率最高的细菌。2009年的耐亚胺培南不动杆菌属的检出率高达60.2%。结论历年血流感染细菌分布无明显变化,以葡萄球菌属、大肠埃希菌和克雷伯菌属及肠球菌属最多见;大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗菌药物耐药率呈逐年增长趋势。利奈唑胺耐药肠球菌属的检出数逐年增加。

Objective To investigate the trend of bacterial distribution and drug resistance isolated from bloodstream infection patients during 2006 to 2011 from Ministry of Health National Antimicrobial Resistant Investigation Net （Mohnarin）. Methods Comprehensive analysis was conducted for clinical used primary antibiotics against important pathogenic microbes from 2006-2011 by meta-analysis. The trends of antimicrobial resistance were analyzed using chi-square test. Results A total of 5 qualified articles were screened out. Coagulase-negative Staphylococci （CNS）was the most isolated bacteria, followed by Escherichia coli, Klebsiella spp., Staphylococcus aureus and Enterococcus spp. occupied for the third to fifth commonly isolated bacteria and varied slightly. The detection rate of methicillin-resistant S. aureus remained at around 50%, and the rate of methicillin-resistant CNS decreased gradually from the year of 2006; vancomycin and linezolid-resistant strains was not detected. The number of linezolid-resistant Enterococcus spp. increased yearly, seven isolates of linezolid-resistant E. faecium and 1 isolate of linezolid-resistant E. faecalis were collected in the year 2011. The ESBLs detection rate ofE. coli and K. pneumoniae were 70.2% and 53.3 % in 2010, respectively. Imipenem-resistant E. coli and K. pneumoniae has significant difference over the years （P〈0.001） and kept an upward trend. The resistant rate reached to 4.3% and 8.3% in 2011, respectively.Acinetobacter spp. and Pseudomonas aeruginosa were the most isolated strains among non-fermentative bacteria, the resistant rate ofAcinetobacter spp. to imipenem was 60.2% in 2009. Conclusion Staphylococcus spp., E. coli, Klebsiella spp. and Enterococcus spp. are the predominant pathogens causing bloodstream infection in China and there is no significant changes in the distribution of bacteria over the years. Carbapenem-resistant E. coli and Klebsiella spp. increased significantly and the number of detected linezolid-resistant Enterococcus spp. kept an upward trend.