中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告

Antimicrobial susceptibility of Gram-negative organisms: Results from China antimicrobial resistance surveillance trial program,2015-2016

目的监测我国主要城市三级甲等医院住院患者分离革兰氏阴性菌耐药状况,掌握细菌耐药流行趋势,为抗菌药物合理使用提供科学数据。方法定点收集来自全国18家医院临床分离细菌,由中心实验室统一用平皿二倍稀释法测定抗菌药物最低抑菌浓度(MIC),参照美国临床和实验室标准协会(CLSI)或欧洲药敏委员会(EUCAST)2017标准判定细菌敏感、耐药率。结果对来自全国18座城市18家医院的4333株临床分离革兰氏阴性致病菌进行了MIC测定。结果显示,大肠埃希菌和肺炎克雷伯菌中超广谱β内酰胺酶(ESBLs)检出率分别为59.4%和27.5%,较前次监测下降7~10个百分点。对肠杆菌科细菌抗菌作用较好的药物包括:碳青霉烯类、阿米卡星、拉氧头孢、酶抑制剂复方制剂、替加环素、磷霉素等,但碳青霉烯类耐药肺炎克雷伯菌比例继续增加。非发酵革兰氏阴性菌中铜绿假单胞菌和鲍曼不动杆菌对亚安培南的耐药率分别为29.5%和69.8%,多重耐药菌(MDR)检出率分别为35.6%和78.3%,泛耐药菌(XDR)检出率分别为10.2%和72.5%。不同病房、不同年龄以及不同标本来源菌株耐药率比较提示,儿童患者分离菌中肺炎克雷伯菌对β内酰胺类等药物耐药率显著高于成年人与老年人,我国儿童中细菌耐药问题不容忽视。结论 ESBLs检出率虽有下降,但碳青霉烯类耐药肺炎克雷伯菌继续增加趋势,须引起注意。

Objective To investigate the antibacterial resistance in nationwide＇s tietiary hospitals and understand the trend of antimicrobial resistance. Methods All the clinical isolates were collected from 18 hospitals and the minimal inhibitory concentrations（ MICs） were tested using agar dilution method recommended by Clinical and Laboratory Standards Institute（ CLSI） in central laboratory. The susceptibilities of isolates to antimicrobial agents were determined by using CLSI or European Committee on Antimicrobial Susceptibility Testing（ EUCAST） 2017 guideline. Results A total of 4333 pathogenic isolates from 18 tertiary hospitals in 18 cities nationwide over the period from July 2015 to June2016 were studied. Based on the MIC results,Escherichia coli and Klebsiella pneumoniae showed extended spectrum β-lactamase（ ESBLs）phenotype rates of 59. 4% and 27. 5%,respectively; decreased by 7 to10 percentage points comparing the last time. Carbapenems,amikacin,moxalactam,β-lactam/β-lactamase inhibitor combinations,tigecycline,and fosfomycin displayed desirable antibacterial activity against Enterbacteriaceae,but a significant increasing of carbapenems resistance Klebsiella pneumoniae were noted. For non-fermenting Gram-negative isolates,resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannnii to imipennnem were 29. 5% and 69. 8% and multidrug-resistant（ MDR） detection rate were 35. 6% and78. 3%,extensively drug-resistant（ XDR） were 10. 2% and 72. 5%,respectively. Klebsiella pneumoniae isolated from children were more resistant to β-lactam than those from adults and the old people,so bacterial resistance in children is an important problem in China. Conclusion Though the decline of ESBLs detection rate,carbapenem non-susceptible Klebsiella pneumoniae rates continued to increase,which should be paid more attention.