2015年CHINET细菌耐药性监测

Report of CHINET Antimicrobial Resistance Surveillance Program in 2015

目的了解国内主要地区临床分离菌对常用抗菌药物的敏感性和耐药性。方法国内主要地区20所医院(18所综合性医院、2所儿童医院)临床分离菌采用纸片扩散法或自动化仪器法按统一方案进行细菌药物敏感性试验。按CLSI2015年版标准判断結果。结果收集2015年1—12月各医院临床分离菌共88 778株,其中革兰阳性菌26 481株,占29.8%,革兰阴性菌62 297株,占70.2%。金黄色葡萄球菌(金葡菌)和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)的平均检出率分别为42.2%和82.6%。MRSA和MRCNS对β内酰胺类抗生素和其他绝大多数测试药的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。MRSA中有92.3%的菌株对甲氧苄啶-磺胺甲噁唑敏感;MRCNS中有85.4%菌株对利福平敏感。未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物(除氯霉素外)的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株,表型或基因型检测结果显示主要为VanA型、VanB型或VanM型耐药。肺炎链球菌非脑膜炎株儿童株中青霉素敏感株所占比例较2014年有所上升,中介和耐药株的检出率均有所下降,但成人株反之。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中产ESBL株平均分别占51.5%、27.4%和22.2%,产ESBL株对测试药物的耐药率均比非产ESBL株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,绝大多数菌株的耐药率低于10%。不动杆菌属(鲍曼不动杆菌占93.4%)对亚胺培南和美罗培南的耐药率分别为62.0%和70.5%。与2014年相比,肺炎克雷伯菌中广泛耐药株的检出率有所上升。结论肺炎克雷伯菌和鲍曼不动杆菌对碳青霉烯类的耐药率仍呈上升趋势,给临床的抗感染治疗带来极大挑战。

Objective To investigate the susceptibility profile of clinical isolates collected from hospitals in several regions of China.Methods Eighteen general hospitals and two children＇s hospitals were involved in this program.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2015.Results A total of 88 778 clinical isolates were collected from January to December 2015,of which gram negative organisms and gram positive cocci accounted for 70.2%（62 297/88 778） and 29.8%（26 481/88 778）,respectively.Methicillin-resistant strains in S.aureus（MRSA） and coagulase negative Staphylococcus（MRCNS） accounted for an average of 42.2% and 82.6%respectively.The resistance rates of MR strains to β-lactams and most other antimicrobial agents were much higher than those of MS strains.However,92.3% of the MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 85.4% of the MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin,teicoplanin or linezolid.In Enterococcus spp.,the resistance rates of E.faecalis strains to most of the antibiotics tested（except chloramphenicol）were much lower than those of E.faecium.A few strains of both species were resistant to vancomycin.Vancomycin resistant strains of E.faecalis and E.faecium were mainly VanA,VanB or VanM type based on their phenotype or genotype.As for the nonmeningitis S.pneumoniae strains,the prevalence of PSSP strains from children was higher than that in 2014,but the prevalence of PISP or PRSP strains was lower than that in 2014.However,the prevalence of PSSP strains from adults was lower than that in2014,but the prevalence of PISP or PRSP strains was higher than that in 2014.The prevalence of ESBLs producing strains was51.5%in E.coli and 27.4%in Klebsiella spp.（K.pneumoniae and K.oxytoca） and 22.2%in Proteus mirabilis isolates on average.ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rates.The strains of Enterobacteriaceae were still highly susceptible to carbapenems.Overall,less than 10% of these strains were resistant to carbapenems.About 62.0% and 70.5% of Acinetobacter spp.（A.baumannii accounts for 93.4%） strains were resistant to imipenem and meropenem,respectively.Compared with the data of year 2014,extensively-drug resistant strains in K.pneumoniae increased.Conclusions The prevalence of carbapenem-resistant K.pneumoniae and A.baumannii is still increasing.Infections due to carbapenem-resistant strains pose huge challenge for clinicians.