2016年上海市细菌耐药性监测

Surveillance of antibiotic resistance among the bacterial strains isolated from hospitals in Shanghai: results of 2016

目的了解2016年上海市细菌耐药性监测结果。方法采用纸片扩散法或自动化仪器法对上海市47所医院的临床分离菌进行药敏试验。包括28所三级医院(床位数31 373张)和19所二级医院(床位数16 311张)。采用CLSI 2016年版标准判断结果。结果 12 2 548株临床分离菌,革兰阳性菌35 522株,占29.0%;革兰阴性菌87 026株,占71.0%。分离菌二级医院和三级医院分别占28.9%和71.1%;其中革兰阳性菌和革兰阴性菌在二、三级医院中分别占25.8%和74.2%、30.3%和69.7%。MRSA和MRCNS的检出率分别为48.7%和77.2%。MRSA、MRCNS在二级医院和三级医院的平均检出率分别为55.9%、73.3%和45.9%、78.6%。葡萄球菌属中未发现万古霉素耐药株。1 111株儿童非脑膜炎肺炎链球菌中青霉素敏感(PSSP)、中介(PISP)和耐药株(PRSP)的检出率分别为77.4%、13.2%和9.4%;上述细菌在二级医院中分别占97.8%、2.2%、0;在三级医院中分别占76.5%、13.7%、9.8%。285株成人分离肺炎链球菌PSSP、PISP和PRSP分别为94.0%、4.2%和1.8%;上述细菌在二级医院中分别占93.7%、5.3%、1.0%;在三级医院中分别占94.2%、3.7%、2.1%。发现37株屎肠球菌(二级医院14株,三级医院23株)和25株粪肠球菌(均分离自三级医院)耐万古霉素。根据PCR测序,多数万古霉素耐药肠球菌(VRE)为van A基因型。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中ESBL的检出率分别为52.2%、30.9%和29.8%。上述产ESBL菌株在二级医院和三级医院的检出率分别为55.1%、33.6%、34.0%和51.0%、29.7%、28.0%。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,对亚胺培南、美罗培南的总耐药率分别为8.9%、9.1%,二级医院和三级医院中耐药率分别为6.6%、7.1%和9.9%、10.0%。鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌中出现对所有测试抗菌药物耐药的广泛耐药株,在二级医院和三级医院分别为223株、63株、10株、4株和224株、201株、22株、9株。结论目前临床主要病原菌对常用抗菌药物的耐药性仍极严重,对医疗机构构成严重威胁,需引起高度重视并采取有效感控措施。

Objective To investigate the resistance profile of clinical bacterial isolates to antibiotics in Shanghai during 2016. Methods Antimicobial susceptibility testing was carried out for the clinical isolates collected from 47 hospitals according to a unified protocol using Kirby-Bauer method or automated systems. The participating hospitals included 28 tertiary hospitals and 19 secondary hospitals across Shanghai. Results were analyzed according to CLSI 2016 breakpoints. Results A total of 122 548 clinical isolates were collected, including 35 522(29.0%) strains of gram positive cocci and 87 026(71.0%) strains of gram negative bacilli. Overall, 28.9% of the isolates were from secondary hospitals and 71.1% from tertiary hospitals. Gram positive and gram negative isolates accounted for 25.8% and 74.2% in secondary hospitals, 30.3% and 69.7% in tertiary hospitals, respectively. The overall prevalence of MRSA in Staphylococcus aureus was 48.7% and 77.2% of MRCNS in coagulase-negative Staphylococcus. The average prevalence of MRSA and MRCNS was 55.9% and 73.3% in secondary hospitals, 45.9% and 78.6% in tertiary hospitals. No strains were found resistant to vancomycin in Staphylococcus. About 77.4% of the 1 111 strains of non-meningitis S. pneumoniaeisolated from children were penicillin-susceptible(PSSP), 13.2% were penicillin-intermediate(PISP) and 9.4% were penicillin-resistant(PRSP). The prevalence of PSSP, PISP, and PRSP was 97.8%, 2.2%, and 0 in secondary hospitals, 76.5%, 13.7%, and 9.8% in tertiary hospitals. Of the 285 strains isolated from adults, 94.0%, 4.2% and 1.8% were PSSP, PISP and PRSP, respectively. The prevalence of PSSP, PISP and PRSP among the isolates from adults was 93.7%, 5.3%, and 1.0% in secondary hospitals, 94.2%, 3.7%, and 2.1% in tertiary hospitals. Overall, 37 strains of vacomycin-resistant E. feacium(14 from secondary hospitals and 23 from tertiary hospitals) and 25 strains of vacomycin-resistant E. feacalis(all from tertiary hospitals) were identified. PCR and sequencing analysis indicated that most of these resistant strains were van A type. The overall prevalence of ESBLs-producing srains was 52.2% in E. coli, 30.9% in Klebsiella pneumoniae and 29.8% in Proteus mirabilis. Specifically, the corresponding prevalence of such strains was 55.1%, 33.6% and 34.0% in secondary hospitals, 51.0%, 29.7% and 28.0% in tertiary hospitals, respectively. Enterobacteriaceaestrains were still highly susceptible to carbapenem antibiotics. Overall, 8.9% and 9.1% of the Enterobacteriaceae strains were resistant to imipenem and meropenem, respectively. The figure was 6.6% and 7.1% in secondary hospitals, 9.9% and 10.0% in tertiary hospitals. Extensively drug-resistant strains were identified in A. baumannii, K. pneumoniae, P. aeruginosa, and E. coli, specifically, 223, 63, 10, and 4 strains in secondary hospitals; 224, 201, 22, and 9 strains in tertiary hospitals. Conclusions Antibicotic resistance is still very serious in the common clinical strains, which poses a critical threat to healthcare facilities. This issue should be taken seriously and effective infection control measures must be put in place.