2005—2014年CHINET铜绿假单胞菌耐药性监测

Resistance profile of Pseudomonas aeruginosa in hospitals across China:the results from the CHINET Antimicrobial Resistance Surveillance Program,2005-2014

目的了解2005-2014年中国不同地区铜绿假单胞菌临床分离株的耐药性和耐药特征,指导临床合理使用抗菌药物。方法对全国19所医院临床分离的铜绿假单胞菌按照统一的方案、采用统一的材料、方法（K-B法）和判断标准,进行铜绿假单胞菌的耐药性监测,并用WHONET 5.6软件进行数据分析。结果 10年间从临床标本中共收集54 196株铜绿假单胞菌,其中90.3%菌株分离自住院患者,70.6%分离自呼吸道标本。10年间,铜绿假单胞菌的检出率总体呈下降趋势：2005年为10.2%,2014年下降至9.5%。铜绿假单胞菌对阿米卡星的耐药率最低,为14.1%。分离自门诊的菌株对各抗菌药物的敏感率在57.4%-83.7%,分离自住院非ICU的菌株对各抗菌药物的敏感率在50.5%-81.8%,而分离自ICU的菌株对各抗菌药物的敏感率为38.5%-75.9%。分离自老年患者的菌株对各抗菌药物的敏感率在45.7%-80.9%,成人患者为49.8%-80.4%,儿童患者为66.0%-91.5%。泛耐药铜绿假单胞菌的检出率平均为1.7%。结论临床分离的铜绿假单胞菌对抗菌药物的耐药率仍处于较高水平,但近年耐药率增长趋势稳定。分离自不同年龄、标本类型及科室的菌株对抗菌药物的耐药性相差较大,医疗机构应加强细菌耐药监测,指导临床合理使用抗菌药物。同时要加强感染控制措施,预防和控制耐药菌株的医院内流行。

Objective To investigate the antimicrobial resistance profile ofP. aeruginosa in the hospitals across China from 2005 through 2014. Methods Clinical isolates ofP. aeruginosa collected from 19 teaching hospitals in China were tested by Kirby-Bauer method and automated systems for their susceptibility to commonly used antimicrobial agents. The data were analyzed by using WHONET 5.6 software. Results Of the 54 196 clinical P. aeruginosa isolates, 90.3% were isolated from inpatients, and 70.6% were isolated from respiratory tract specimens. The prevalence ofP aeruginosa decreased with time from 10.2% in 2005 to 9.5% in 2014. The P. aeruginosa isolates showed the lowest resistance rate （14.1%） to amikacin. About 57.4%-83.7% of the P aeruginosa strains from outpatients, 50.5%-81.8% of the strains from non-ICU inpatients and 38.5%-75.9% of the strains from ICU inpatients were susceptible to the antimicrobial agents tested. About 45.7%-80.9% of the strains from old patients, 49.8%-80.4% of the strains from adults and 66.0%-91.5% of the strains from children were susceptible to the antimicrobial agents tested. The prevalence of pan- drug resistant strains was 1.7% in the P aeruginosa isolates. Conclusions The results indicate that the resistance of P. aeruginosa isolates in China is relatively serious. The resistance rates remain steady to most antimierobial agents. The antimicrobial susceptibility pattern varies with patient age, specimen type, and the department where the strain was isolated. Surveillance of antimicrobial resistance is important for rational antimicrobial therapy and effective prevention and control of the spread of resistant P. aeruginosa strains in hospitals.