世界卫生组织关注的临床重要细菌耐药变迁:北京协和医院10年数据分析

Changes of Antibiotic Resistance of Clinically Important Bacteria that World Health Organization is Concerned about: 10-Year Data Analysis of Peking Union Medical College Hospital

目的了解世界卫生组织关注的临床重要细菌在北京协和医院的耐药变迁趋势。方法回顾性分析北京协和医院2007年1月1日至2016年12月31日10年间临床分离的46 168株非重复细菌,采用纸片扩散法或自动化仪器法进行药敏试验,按美国临床实验室标准化协会2016年版标准判读药敏结果,采用WHONET 5.6软件进行数据分析。结果46 168株非重复细菌中,铜绿假单胞菌6679株,鲍曼不动杆菌6422株,肠杆菌科细菌24 001株(其中大肠埃希菌11 046株、肺炎克雷伯菌6034株),屎肠球菌2358株,金黄色葡萄球菌6056株,肺炎链球菌652株。10年来,北京协和医院碳青霉烯类耐药铜绿假单胞菌的检出率从38.3%(2007年)下降至22.4%(2016年);碳青霉烯类耐药鲍曼不动杆菌的检出率从52.8%(2007年)上升至71.9%(2016年);碳青霉烯类耐药肠杆菌科的检出率从1.9%(2007年)上升至5.3%(2016年),其中肺炎克雷伯菌对亚胺培南的耐药率从1.3%(2007年)上升至14.4%(2016年);耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)的检出率从56.5%(2007年)下降至27.0%(2016年);屎肠球菌对万古霉素的耐药率近5年为3.3%~5.8%;肺炎链球菌对青霉素不敏感株的检出率近2年为0.9%~6.4%。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了极大挑战。

Objective This study was to investigate the antibiotic resistance profile of clinically important bacteria that World Health Organization （WHO） is concerned about, in Peking Union Medical College Hospital （PUMCH） from January 1, 2007 to December 31, 2016. Methods Disc diffusion test （Kirby-Bauer method） and automated systems were employed to detect antibiotic resistance. Data were analyzed by WHONET 5. 6 soft-ware according to the 2016 edition of antbioticl susceptibility testing standards issued by the Clinical and Labora-tory Standards Institute （CLSI） of the United States. Results A total of 46 168 non-duplicated main clinical isolates were collected in PUMCH from 2007 to 2016, including 6679 strains of Pseudomonas aeruginosa, 6422 strains of Acinetobacter baumannii, 24 001 strains of Enterobacteriaceae （11 046 strains of Escherichia coli and 6034 strains of Klebsiella pneumonia） , 2358 strains of Enterococcus faecium, 6056 strains of Staphylococcus aureus, 652 strains of Streptococcus pneumonia, and 999 strains of Haemophilus influenza. Based on the surveillance data during the 10 years, we found that, the detection rate of the carbapenem-resistant P. aeruginosa decreased from 38. 3% in 2007 to 22. 4% in 2016; the detection rate of carbapenem-resistant A. baumannii increased from 52. 8% in 2007 to 71. 9% in 2016; the imipenem-resistance rate of K. pneumonia increased from 1. 3% in 2007 to 14. 4% in 2016. The vancomycin-resistance rate of E. faecium was 3. 3%-5. 8% in recent 5 years. The detection rate of Methicillin-resistant S. aureus （MRSA） decreased from 56. 5% in 2007 to 27. 0% in 2016. The detection rate of penicillin-insensitive S. pneumonia was 0. 9%-6. 4% in recent 2 years. Conclusions The prevalence of carbapenem-resistant K. pneumoniae and A. baumannii is still increasing. Carbapenem- resistant strains pose a huge challenge for anti-infection therapy.