2005—2014年CHINET志贺菌耐药性监测

Antibiotic resistance profile of Shigella isolates in hospitals across China:results of CHINET Antimicrobial Resistance Surveillance Program 2005-2014

目的了解2005年1月—2014年12月中国不同地区19所医院临床分离志贺菌属的构成、分布及耐药性。方法收集19所教学医院临床分离的志贺菌属,按照统一方案,采用纸片扩散法或自动化仪器法进行药敏试验,按美国临床和实验室标准化协会（CLSI）2014年版标准判读结果,采用WHONET5.6进行数据统计分析。结果共收集到各医院临床分离志贺菌属1 110株。其中宋内志贺菌检出率48.4%,福氏志贺菌检出率46.2%。10年间,志贺菌属所测试药物中对氨苄西林耐药率最高（83.3%-97.6%）,其次是甲氧苄啶-磺胺甲唑（55.6%-92.3%%）、头孢曲松（0-58.3%）、氨苄西林-舒巴坦（18.7%-64.4%）、阿莫西林-克拉维酸（6.8%-100%）、氯霉素（0-60%）、环丙沙星（6.8%-46.2%）。成人分离株对环丙沙星、头孢曲松的的耐药率分别为41.1%和25.5%,而儿童分离株对两者耐药率分别为17.2%和54.0%。结论10年间,临床分离的志贺菌属以宋内志贺菌和福氏志贺菌为主,上述分离株对喹诺酮类抗菌药物耐药率相对较低,对氨苄西林和甲氧苄啶-磺胺甲唑耐药率高;成人分离株对环丙沙星的耐药率高于儿童,对头孢曲松、氯霉素和阿莫西林-克拉维酸的耐药率低于儿童分离株。药敏试验结果提示临床上常规使用氨苄西林和甲氧苄啶-磺胺甲唑治疗志贺菌感染可能会导致治疗失败。

Objective To investigate distribution and resistance profile of clinical Shigella isolates in hospitals across China from January 2005 through December 2014. Methods The Skigella isolates were collected for antimicrobial susceptibility testing by means of a unified protocol using Kirby-Bauer method and MIC determination. The results were analyzed according to CLSI 2014 breakpoints. Results A total of 1 110 Shigella strains were isolated from nineteen hospitals. The proportion of Skigella sonnei and Skigellaflexneri were 48.4% and 46.2%, respectively. Over the 10-year period, the highest resistance rate was to ampicillin （83.3%-97.6%）, followed by trimethoprim-sulfamethoxazole （55.6%-92.3%）, ceftriaxone （0-58.3%）, ampicillin-sulbactam （18.7%- 64.4%）, amoxicillin-clavulanic acid （6.8%-100%）, chloramphenicol （0-60%）, and ciprofloxacin （6.8%-46.2%）. Overall, 41.1% and 25.5% of the strains isolated from adults were resistant to ciprofloxacin and ceftriaxone, respectively. However, only 17.2% and 54.0% of the strains from children were resistant to ciprofloxacin and ceftriaxone, respectively. Conclusions In the 10-year period, most Skigella isolates were Shigella sonnei and Shigellaflexneri in the hospitals across China. The Shigella isolates showed relatively low resistance rate to quinolones, but higher resistance rate to ampicillin and trimethoprim-sulfamethoxazole. The strains from adults had higher resistance rate to ciprofloxacin than the strains from children, but lower resistance rate to ceftriaxone, chloramphenical and amoxicillin-clavulanic acid than the strains from children. The treatment with ampicillin and trimethoprim-sulfamethoxazole may result in failure in Shigella infections.