中国细菌耐药监测研究2013至2014年非发酵革兰阴性菌监测报告

Antimicrobial susceptibility of nonfermenting gram-negative bacteria： results from China Antimicrobial Resistance Surveillance Trial Program, 2013 - 2014

目的监测我国主要城市三级甲等医院住院患者非发酵革兰阴性菌耐药状况，掌握耐药流行趋势，为抗生素合理使用提供科学数据。方法按照统一方案定点收集来自全国19座城市19家医院2013年7月至2014年6月临床分离致病菌，每家医院约100株，由北京大学第一医院临床药理研究所作为中心实验室，统一采用平皿二倍稀释法测定抗菌药物MIC，参照美国CLSI或欧洲药敏委员会（EUCAST）2015标准判定细菌敏、耐药，以统计软件SPSS17．0计算MIC50、MIC90、MICm目及敏感率、耐药率。结果共1535株细菌进入MIC结果统计，铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为28．0％（180／644）和70．5％（456／647），多重耐药（MDR）菌检出率分别为34．9％（225／644）和79．6％（515／647），泛耐药（XDR）菌检出率分别为9．8％（63／644）和72．2％（467／647）。不同病房、不同年龄以及不同标本来源菌株耐药率比较显示，分离自ICU菌株的耐药率高于非ICU菌株，其中鲍曼不动杆菌更为明显，来自ICU菌株耐药率多在52．4％～90．9％，明显高于分离自非ICU菌株的34．0％～73．3％（t=2．209，P=0．032）；儿童患者分离菌中非发酵菌所占比例及耐药率均显著低于成人患者与老年患者（3．2％～50．0％、7．1％～81．3％，t=-2．800～-5．671，P均〈0．01）；来自痰标本的铜绿假单胞菌较来自血和引流液的菌株更耐药（18．7％～74．2％、0．0％～75．4％，t=2．337～2．707，P均〈0．05）；来自引流液的鲍曼不动杆菌耐药率显著高于来自尿标本的菌株（19．7％～88．2％VS6．0％～66．0％，t=2．884，P=0．006）。结论铜绿假单胞菌、嗜麦芽窄食单胞菌、洋葱伯克霍尔德菌近年来耐药率稳定，但鲍曼不动杆菌耐药率持续增长，特别对于原本具有较好体外抗菌作用的药物，如米诺环素等。非发酵革兰阴性菌多重耐药已成为世界关注问题。

Objective To investigate the antimicrobial susceptibility of nonfermenting gramnegative bacteria in nationwide＇ s tertiary hospitals and understand the trend of antimicrobial resistance. Methods The clinical isolates were collected from 19 tertiary hospitals in 19 cities nationwide over the period from July 2013 to June 2014 according to the same protocol. About 100 strains were collected from each hospital. The minimal inhibitory concentrations （MICs） were tested using agar dilution method recommended by Clinical and Laboratory Standards Institute （CLSI） in the central laboratory （Institute of Clinical Pharmacoloty, Peking University First Hospital ）. The susceptibilities of isolates to antimicrobial agents were determined using CLSI or European Committee on Antimicrobial Susceptibility Testing （EUCAST） 2015 guideline. SPSS 17.0 was used to caculated MICs0, MICg0, MICra,g,, susceptible rate and resistance rates. Results A total of 1 535 pathogenic isolates were studied. Based on the MIC results, resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 28.0% （ 180/ 644） and 70. 5% （456/647） . Multidrug resistance rate of P. aeruginosa and A. baumannii were 34. 9% （225/644） and 79. 6% （515/647）, and extensively drug-resistance rate were 9.8% （63/644） and 72. 2% （467/647）, respectively. Resistance rate of strains isolated from intensive care unit （ICU） were higher than those from non-ICU, especially in A. baumannii （about 52. 4% -90. 9% vs 34. 0% -73.3%, t=2. 209, P = 0. 032）. Relevance ratio and resistance rate of nonfermenting gram-negative bacteria in children （ ≤ 14 years） were significantly lower than those from adults and old people （ ≥65 years） （about 3.2% - 50. 0% vs 7. 1% - 81.3% , t = - 2. 800 - - 5. 671, P 〈 0.01）. Resistance rate of P. aeruginosa isolated from sputum were higher than those isolated from blood and drainage fluid （about 18.7% -74. 2% vs 0. 0% -75.4% , t=2. 337 -2. 707, P 〈0. 05）, and resistance rate ofA. baumannii isolated from drainage fluid were higher than urine （ about 19.7% - 88.2% vs 6. 0% - 66. 0%, t = 2. 884, P = 0. 006）. Conclusions Compared with past surveillance results, resistance rates of. P. aeruginosa, Stenotrophomonas maltophilia, and Burkholderia cepacia were steady. Sustained growth of resistance rate of A. baumannii was identified, especially to some antibiotics showing good in vitro activity former, such as minocyclin et al. Multidrug resistance nonfermenting gram-negative bacterial has been a worldwide challenge for healthcare management.