2005-2014年CHINET克雷伯菌属细菌耐药性监测

Changing susceptibility of Klebsiella strains in hospitals across China: data from the CHINET Antimicrobial Resistance Surveillance Program, 2005-2014

目的了解2005—2014年CHINET细菌耐药性监测网所属19所医院临床分离克雷伯菌属细菌的分布及耐药性变迁情况。方法采用纸片扩散法或自动化仪器法对临床分离株作药物敏感性试验,并按CLSI 2014年版标准判断药敏试验结果。结果 2005—2014年共收集19所医院临床分离的肺炎克雷伯菌56 281株、产酸克雷伯菌4 779株、肺炎克雷伯菌臭鼻亚种300株及其他克雷伯菌属细菌46株。其中89.0%菌株（54 664/61 406）分离自住院患者。60.0%菌株（36 835/61 406）分离自呼吸道。成人来源的克雷伯菌属占83.3%（51 158/61 406）,儿童（0-17岁）占16.7%（10 248/61 406）。10年间,克雷伯菌属细菌的检出率呈逐年上升趋势：2005年为10.1%,2014年为14.3%。药敏试验结果显示,10年里克雷伯菌属对碳青霉烯类药物耐药率呈上升趋势,对亚胺培南和美罗培南耐药率分别从2.9%上升到10.5%和2.8%上升到13.4%。产ESBL肺炎克雷伯菌和产酸克雷伯菌检出率从39.0%下降到30.1%。细菌对阿米卡星、环丙沙星、头孢他啶、哌拉西林-他唑巴坦和头孢哌酮-舒巴坦耐药率呈下降趋势,对头孢噻肟耐药率波动幅度较小,维持在49.5%左右。共检出碳青霉烯类耐药菌5 796株,其中肺炎克雷伯菌5 492株,产酸克雷伯菌280株。分离出广泛耐药菌共4 740株,其中肺炎克雷伯菌4 520株,产酸克雷伯菌202株。碳青霉烯类耐药株对绝大多数其他测试的抗菌药物耐药率均在60%以上,对替加环素、阿米卡星、甲氧苄啶-磺胺甲唑耐药率分别为16.8%、54.4%、55.1%。结论临床分离克雷伯菌属细菌对碳青霉烯类抗生素的耐药率10年间呈较大幅度增加,对其他常用抗菌药物耐药率较为平稳。

Objective To evaluate the changing pattern of antibiotic resistance in Klebsiella strains isolated from the patients in 19 hospitals across China based on the data from CHINET Antimicrobial Resistance Surveillance Program during the period from 2005 through 2014. Methods Kirby-Bauer disk diffusion and automated susceptibility testing methods were used to test the susceptibility of Klebsiella isolates to the commonly used antibiotics. The results were interpreted according to the criteria of the Clinical and Laboratory Standards Institute （CLSI） Performance Standards for Antimicrobial Susceptibility Testing （CLSI-2014）. Results A total of 61 406 Klebsiella strains were identified between 2005 and 2014, including K. pneumoniae （56 281 strains）, K. oxytoca （4 779）, Klebsiella pneumoniae subsp. Ozaenae （300） and other Klebsiella species （46）. Most （89.0%, 54 664/61 406） of the Klebsiella strains were isolated from inpatients, and 60.0% （36 835/61 406） were from respiratory tract speciems. About 16.7% （10 248/61 406） of the strains were isolated from pediatric patients aged 0-17 years and 83.3% （51 158/61 406） from adult patients. The prevalence ofKlebsiella spp. increased with time from 10.1% in 2005 to 14.3% in 2014. Based on the surveillance data during the 10-year period, we found a marked increase of resistance to imipenem （2.9% to 10.5%） and meropenem （2.8% to 13.4%） in Klebsiella spp. The prevalence of ESBLs-producing isolates in K. pneumoniae and K. oxytoca decreased from 39.0% in 2005 to 30.1% in 2014. The resistance to amikaein, ceftazidime, ciprofloxacin, pipracillin-tazobactam and cefoperazone-sulbactam was on decline. The resistance rate to cefotaxime remained high about 49.5%. Carbapenem resistantance was identified in 5 796 （9.4%） of the isolates, including 5 492 strains ofK. pneumoniae and 280 strains ofK. oxytoca. Overall, 4 740 （7.8%） strains were identified as extensively-drug resistant （XDR）, including 4 520 strains ofK. pneumoniae and 202 strains ofK. oxytoca. The carbapenem-resistant strains showed high （〉 60%） resistance rate to majority of the antimicrobial agents tested, but relatively low resistance to tigecycline （16.8%）, amikacin （54.4%）, and trimethoprim-sulfamethoxazole （55.5%）. Conclusions During the 10-year period from 2005 through 2014, carbapenem resistance among Klebsiella isolates has increased dramatically in the hospitals across China. The level of resistance to other antibiotics remains stable.