四川省细菌耐药监测网2014年细菌耐药监测数据分析

Sichuan provincial antimicrobial Resistant Investigation Net 2014 annual report:Bacterial drug resistance surveillance in Sichuan

目的对四川省细菌耐药监测网成员单位2014年度细菌分布及耐药情况进行统计分析,为本省临床合理应用抗菌药物提供依据。方法各成员单位临床分离菌,采用标准纸片扩散法或自动化仪器检测法,按照统一技术方案测定监测药物对细菌的敏感性,依据CLSI2014年标准,用WHONET 5.6软件进行数据分析。结果共有71家医院参加了2014年度细菌耐药监测工作,其中数据基本合格纳入分析的共69家。按患者首次分离菌株进行统计分析,共收集细菌134681株,其中革兰阴性菌99054株(73.5%),革兰阳性菌35627株(26.5%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为26.0%和82.1%,MRSA自2011年起呈下降趋势,未发现万古霉素、利奈唑胺不敏感的葡萄球菌。万古霉素耐药粪肠球菌和屎肠球菌分别占0.7%和4.2%,利奈唑胺耐药粪肠球菌和屎肠球菌分别占1.9%和0.7%。按非颅内感染的折点判断,青霉素耐药的肺炎链球菌比例为2.8%,化脓性链球菌主要对大环内酯类、克林霉素耐药,耐药率均超过55.0%。革兰阴性菌中分离率前3位分别为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌,分别为29965株(30.3%)、18508株(18.7%)和12170株(9.0%)。大肠埃希菌耐药比较突出,对喹诺酮类耐药率在55.0%以上,对第三代头孢菌素中的头孢噻肟和头孢曲松的耐药率自2012年起呈下降趋势,肠杆菌科细菌对碳青霉烯类抗菌药物总耐药率虽低于10.0%,但耐药率自2011年起有逐渐上升趋势。铜绿假单胞菌对碳青霉烯类、氨基糖苷类、哌拉西林/三唑巴坦、多黏菌素B、头孢吡肟、头孢哌酮/舒巴坦、头孢他啶的耐药率低于15.0%,耐碳青霉烯类铜绿假单胞菌比例自2012年起有所下降;鲍曼不动杆菌对包括碳青霉烯类在内的大多数监测药物耐药率超过50.0%,亚胺培南和美罗培南的耐药率分别为60.8%和59.3%,自2011年开始呈明显上升趋势。结论我省细菌耐药仍呈增长趋势,多重耐药和广泛耐药菌株检出率的增加对临床治疗造成严重威胁,应充分利用本地细菌耐药监测结果进行感控管理,促进抗菌药物合理应用。

Objective To explore the bacterial drug resistance and its epidemic tendency in 2014 from the members of Antimicrobial Resistant Investigation Net of Sichuan province, and to guide the rational use of antimicrobial drugs. Methods All the objective bacterial isolates were collected and identified by unified protocol, then analyzed the susceptibility date by software WHONET 5.6 which was detected with the method of disc-diffusion or automatic clinical microbiological systems. Results 134,681 bacterial isolates and their antibacterial susceptibility data were collected from all the 69 members of Antimicrobial Resistant Investigation Net, which included 99054 （73.5%） gram-negative bacterial isolates and 35627（26.5%） Gram-positive bacterial isolates. The isolating rates of methicillin-resistant Staphylococcus aureus （MRSA） and methicillin-resistant coagulase negative Staphylococcus （MRCNS） were 26.0% and 82.1%, respectively, the rate of MRSA appears a decrease trend year by year from 2011. No vancomycin and linezolid non-sensitive Staphylococcus isolates were found. There were 0.7% E. faecalis and 4.2% E. faecium resistant to vancomycin, which were 1.9% and 0.7% resistant to linezolid. According to non-CNS 2.8% penicillin-resistant Streptococcus pneumoniae were found. S. pyogenes was resistant to macrolides and clindamycin mainly, whose resistance rates were both above 55.0%. The top three populations of gram-negative bacterial isolates were E. coli （29965 isolates, 30.3%）, K. pneumoniae （18508 isolates, 18.7%）, P. aeruginosa （12170 isolates, 12.3%）, respectively. The most outstanding resistance rates of Gram-negative bacterial isolates was E. coli whose resistance rate to quinolones was above 40.0%, and that were both above 60.0% to cefotaxime and ceftriaxone. Even the total carbapenem-resistance rate of the Enterobacteriaceae was below 10.0%, but the resistance rates have been on the rise year by year from 2011. The susceptible rates of P. aeruginosa to cefoperazone/sulbactam, amikacin, tobramycin, polymyxin B and carbapenem were all above 80.0%. The resistance rates ofA. baumannii to most surveillance drugs including carbapenem were above 50.0%, which to imipenem and meropenem was 60.8% and 59.3%, respectively, higher than the data of 2012. Conclusion It is severe that the situation of bacterial drug resistance in Sichuan province. We should fully use bacterial drug resistance surveillance results for supervision and administration, and to take effective measures for the control of the spread of resistant isolates.