2005—2014年CHINET肠球菌属细菌耐药性监测

Resistance profile of Enterococcus in hospitals across China:results of CHINET Antimicrobial Resistance Surveillance Program, 2005-2014

目的总结2005—2014年中国主要地区临床分离肠球菌属对各类抗菌药物的耐药性变迁。方法 CHINET细菌耐药性监测网各医院按统一方案、采用统一的材料、方法(K-B法)和判断标准进行肠球菌属细菌的耐药性监测。结果2005—2014年共分离到42 185株非重复肠球菌属细菌,最常见菌种为粪肠球菌(47.3%)、屎肠球菌(43.5%)、鸟肠球菌(1.9%)、鹑鸡肠球菌(1.8%)、铅黄肠球菌(0.6%)。10年间,肠球菌属细菌的检出率呈下降波动趋势:2005年为9.1%,2014年为8.7%。肠球菌属对利奈唑胺、万古霉素、替考拉宁、替加环素仍高度敏感,耐药率<4%,万古霉素耐药粪肠球菌和屎肠球菌检出率分别为0.3%、3.2%。粪肠球菌对氨苄西林、高浓度庆大霉素耐药率分别为10.9%、38.0%,尿液标本分离株对呋喃妥因、磷霉素耐药率低,分别4.8%、6.2%,粪肠球菌耐药率有逐年下降趋势;屎肠球菌耐药率明显高于粪肠球菌,对氨苄西林、环丙沙星、利福平耐药率>80%,对高浓度庆大霉素耐药率为60.8%,对氯霉素耐药率为7.0%,对万古霉素耐药率从2005年0.6%上升至2014年4.2%。结论肠球菌对利奈唑胺、万古霉素、替考拉宁、替加环素依然保持较好的敏感性,但屎肠球菌中万古霉素耐药率有逐年增加趋势,应引起重视。

Objective To investigate the antimicrobial resistance of Enterococcus strains isolated from hospitals across China during the period from 2005 through 2014. Methods Antimicrobial susceptibility testing was carried out by means of Kirby-Bauer method according to the unified protocol. The data were analyzed by using WHONET 5.6 software according to CLSI 2014 breakpoints. Results A total of 42 185 nonduplicate Enterococcus isolates were collected from 2005 through 2014. The most frequently isolated species were E. faecalis （47.3%）, E. faecium （43.5%）, E. avium （1.9%）, E. gallinarum （1.8%） and E. casseliflavus （0,6%）. The prevalence of Enterococcus spp. decreased with time from 9.1% in 2005 to 8,7% in 2014. The strains of Enterococcus were still highly susceptible to linezolid, vancomycin, teieoplanin and tigecycline （overall 〈 4% resistant）. The prevalence of vancomycin- resistant E. faecalis and E.faecium was 0.3% and 3.2%, respectively. And 10.9% and 38.0% of the E. faecalis isolates were resistant to ampicillin and gentamicin （high level）, respectively. Only 4.8% and 6.2% of the E. faecalis strains isolated from urine were resistant to nitrofurantoin and fosfomycin, respectively. E. faecalis showed deceasing resistance rate to these agengts during the period from 2005 through 2014. The E. faecium strains were more resistant than E. faecalis to most of the antibiotics tested. More than 80% of the E. faecium strains were resistant to ampicillin, ciprofloxacin and rifampin, and 60.8% resistant to gentamicin （high level）. But only 7.0% of these strains were resistant to chloramphenicol. The prevalence of vancomycin-resistant strain in E. faeciurn increased from 0.6% in 2005 to 4.2% in 2014. Conclusions Linezolid, vancomycin, teicoplanin and tigecycline are still highly active against Enterococcus isolates, but attention should be paid to the increasing vancomycin resistance in E. faecium.