我国细菌耐药现状与特征

Epidemiology and characteristics of antibacterial resistance in China

目前，我国临床细菌耐药状况十分严峻，各种常见多重耐药菌和泛耐药菌的检出率比较高。就革兰阳性菌而言，主要的耐药细菌包括甲氧西林耐药金黄色葡萄球菌（ MRSA）、大环内酯耐药链球菌；对糖肽类耐药肠球菌尚处于较低水平。我国MRSA分子型别和链球菌的耐药机制与欧美国家有所不同。肠杆菌科细菌主要对头孢菌素和喹诺酮类耐药突出，耐药率超过60％，且近年来对碳青霉烯类耐药的肺炎克雷伯菌呈较快上升态势，耐药的主要机制是细菌产生KPC-2型碳青霉烯酶，给临床治疗带来了重大挑战。铜绿假单胞菌的耐药情况相对比较稳定，耐药率大多在20％～30％；多重耐药鲍曼不动杆菌是临床面临的重大难题，该菌对碳青霉烯类、头孢菌素等的耐药率超过50％，对替加环素耐药的菌株也日益多见。该文结合细菌耐药监测数据和细菌耐药机制研究结果，系统阐述了近五年我国细菌耐药的现状与特征。

Currently, bacterial resistance situation in health care settings is very serious in China, and the prevalence of a variety of common multidrug-resistant bacteria and pan-resistant bacteria are relatively high. Drug-resistant bacteria in Gram-positive bacteria are mainly methicillin resistant Staphylococcus aureus （ MRSA ） and macrolide-resistant Streptococcus, while glycopeptide-resistant enterococci are still at a low level.The clonal distribution of MRSA and mechanisms of Streptococcus resistance in China are different from those in European and American countries.Cephalosporins and quinolones resistance are the marked characteristic of Enterobacteriaceae with a high occurrence over 60%. Carbapenem-resistant Klebsiella pneumoniae shows a rapid upward trend, and producing KPC-2 type carbapenemases is the main mechanism of its resistance.Resistance in Pseudomonas aeruginosa is relatively stable, with resistant rates ranging from 20%to 30%.Multi-drug resistant Acinetobacter baumannii is a big problem in clinic.More than 50% Acinetobacter baumannii strains are resistant to carbapenems and cephalosporins, and tigecycline-resistant Acinetobacter baumannii is increasing.This paper systematically reviews the status and characteristics of bacterial resistance in last five years with referring to the surveillance data of antimicrobial resistance and the findings of related mechanisms.