全国细菌耐药监测网2014—2019年门诊患者临床分离细菌耐药监测报告

Antimicrobial resistance of clinically isolated bacteria from outpatients:surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019

目的监测2014—2019年全国门诊患者临床分离菌株分布情况及对抗菌药物的敏感性。方法按照全国细菌耐药监测网(CARSS)方案,应用WHONET 5.6软件对2014—2019年所有CARSS成员单位上报的门诊患者临床分离细菌及药敏结果数据进行分析。结果2014—2019年门诊患者分离的总菌株数为53243~91692株,其中革兰阴性菌分别占75.3%、57.3%、58.3%、58.5%、60.5%和60.9%,革兰阳性菌分别占24.7%、42.7%、41.7%、41.5%、39.5%和39.1%。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为25.1%~27.8%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率为68.3%~72.4%。MRSA和MRCNS对绝大多数抗菌药物的耐药率均高于甲氧西林敏感株,未发现对万古霉素、替考拉宁及利奈唑胺耐药的菌株。粪肠球菌对多数测试抗菌药物的耐药率均低于屎肠球菌,两者中均有少数耐万古霉素菌株。非脑脊液标本分离的肺炎链球菌对青霉素的耐药率为1.0%~2.3%。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南耐药率分别为10.7%~15.2%、38.5%~49.4%。大肠埃希菌对头孢噻肟的耐药率为48.0%~55.6%,对亚胺培南的耐药率为0.6%~0.8%;肺炎克雷伯菌对头孢噻肟的耐药率为31.0%~38.3%,对亚胺培南的耐药率为3.9%~6.3%。流感嗜血杆菌对氨苄西林的耐药率为37.5%~55.6%。结论门诊患者临床分离菌对常见抗菌药物的耐药性形势仍较严峻,尤其是耐碳青霉烯类革兰阴性杆菌和耐甲氧西林葡萄球菌。

Objective To surveil the distribution and antimicrobial susceptibility of clinically isolated bacteria from outpatients in China from 2014 to 2019.Methods According to China Antimicrobial Resistance Surveillance System(CARSS)program,clinically isolated bacteria and antimicrobial susceptibility testing results of outpatients reported by all CARSS member hospitals in 2014-2019 were analyzed by WHONET 5.6 software.Results The total number of bacteria isolated from outpatients in 2014-2019 were 53243-91692 strains,Gram-negative bacteria accounted for 75.3%,57.3%,58.3%,58.5%,60.5%and 60.9%respectively,Gram-positive bacteria accounted for 24.7%,42.7%,41.7%,41.5%,39.5%and 39.1%respectively.Isolation rates of methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant coagulase negative Staphylococcus(MRCNS)were 25.1%-27.8%and 68.3%-72.4%respectively.Resistance rates of MRSA and MRCNS to most antimicrobial agents were higher than those of methicillin susceptible strains,vancomycin-,teicoplanin-and linezolid-resistant strains were not found.Resistance rates of Enterococcus faecalis to most tested antimicrobial agents were lower than those of Enterococcus faecium,and both had a few vancomycin-resistant strains.Resistance rate of Streptococcus pneumoniae isolated from non-cerebrospinal fluid specimens to penicillin were 1.0%-2.3%.Resistance rates of Pseu-domonas aeruginosa and Acinetobacter baumannii to imipenem were 10.7%-15.2%and 38.5%-49.4%respectively;resistance rates of Escherichia coli to cefotaxime and imipenem were 48.0%-55.6%and 0.6%-0.8%respectively;resistance rates of Klebsiella pneumoniae to cefotaxime and imipenem were 31.0%-38.3%and 3.9%-6.3%respectively.Resistance rates of Haemophilus influenzae to ampicillin were 37.5%-55.6%.Conclusion Antimicrobial resistance of clinically isolated bacteria from outpatients is still serious,especially carba-penem-resistant Gram-negative bacilli and methicillin-resistant Staphylococcus.