2019年上海市二级医院细菌耐药监测

Surveillance of bacterial resistance in secondary hospitals across Shanghai in 2019

目的了解2019年上海市二级医院临床分离菌对抗菌药物的耐药性。方法对21所二级医院(包括6所三乙医院)临床分离菌采用纸片扩散法或自动化仪器法按上海市细菌真菌耐药监测网统一监测方案进行抗菌药物敏感性试验。按2019年美国临床和实验室标准化协会(CLSI)文件标准判断结果。结果收集2019年1-12月上述医院临床分离菌共48650株,其中革兰阳性菌12409株,占25.5%,革兰阴性菌36241株,占74.5%。金黄色葡萄球菌、表皮葡萄球菌和其他凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA、MRSE和其他MRCNS)的平均检出率分别为49.6%、78.4%和79.9%。MRSA和MRCNS对大多数测试药物的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。葡萄球菌属中未见万古霉素耐药株。肠球菌属中粪肠球菌对多数受试抗菌药物的耐药率均显著低于屎肠球菌,粪肠球菌对利奈唑胺耐药率0.4%,屎肠球菌对万古霉素耐药率为0.3%。流感嗜血杆菌、肺炎链球菌和卡他莫拉菌检出率分别为2.5%(1235株)、0.4%(217株)和0.5%(238株),流感嗜血杆菌产β内酰胺酶率为51.3%。肺炎链球菌非脑脊液分离株中以成人分离株为多,占61.7%,成人中青霉素耐药肺炎链球菌(PRSP)检出率为4.5%(6/132),儿童中未发现PRSP菌株。肠杆菌目细菌对碳青霉烯类抗生素较敏感,多数菌属对美罗培南耐药率均低于4%,克雷伯菌属对亚胺培南和美罗培南的耐药率分别为23.6%和23.2%,沙雷菌属对两药耐药率分别为21.4%和16.0%。不动杆菌属细菌对上述两药的耐药率分别为52.1%和53.2%,铜绿假单胞菌对两药的耐药率分别为22.1%和20.5%。结论2019年上海市二级医院细菌耐药性监测显示:其菌种的分布和耐药性与三级医院大致相仿,临床常见细菌的耐药率和MRSA、碳青霉烯类耐药的肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌等耐药菌株的检出率较高,面临细菌耐药增加的严重威胁,应引起足够重视;合理使用抗菌药物和规范治疗是当务之急。

Objective To investigate the susceptibility and resistance of clinical isolates collected from secondary care hospitals across Shanghai in 2019.Methods A total of 21 secondary hospitals were involved in this program.Antimicrobial susceptibility testing was carried out according to a unified protocol of Shanghai Antimicrobial Resistance Surveillance Network using Kirby-Bauer method or automated systems.We analyzed according to CLSI 2019 breakpoints.Results A total of 48650 clinical isolates were collected from January to December 2019,of which gram negative organisms and gram positive cocci accounted for 74.5% and 25.5%,respectively.Methicillin-resistant strains in S.aureus(MRSA),S.epidermidis(MRSE),and other coagulase negative Staphylococcus(MRCNS)accounted for an average of 49.6%,78.4%,and 79.9%,respectively.MR strains(MRSA and MRCNS)showed much higher resistance rates to most other antimicrobial agents than MS strains(MSSA and MSCNS).No staphylococcal strains were found resistant to vancomycin.E.faecalis strains demonstrated much lower resistance rates to most of the drugs tested than E.faecium strains.No vancomycin-resistant strain was found in E.faecalis,but 0.4% of the E.faecalis strains were resistant to linezolid.No linezolid-resistant strain was found in E.faecium,but 0.3% of the E.faecium strains were resistant to vancomycin.The proportion of Haemophilus influenzae,Streptococcus pneumoniae,and Moraxella catharsis was 2.5%,0.4%,and 0.5%,respectively among all the bacterial isolates.The prevalence of β-lactamase-producing H.influenzae was 51.3%.Most(61.7%)of the nonmeningitis S.pneumoniae strains were isolated from adults.The prevalence of PRSP was 4.5%.No PRSP strain was isolated from children.Enterobacterales strains were still highly susceptible to carbapenems.Overall,less than 4% of these strains were resistant to carbapenems.The resistance rate of Klebsiella spp.to imipenem and meropenem was 23.6% and 23.2%,respectively.About 21.4%and 16.0% of the Serratia strains,52.1% and 53.2%of Acinetobacter strains,22.1% and 20.5% of Pseudomonas aeruginosa strains,were resistant to imipenem and meropenem,respectively.Conclusions The antimicrobial resistance surveillance in secondary care hospitals across Shanghai in 2019 showed that the distribution of bacterial strains and antibiotic resistance profiles were similar to those in tertiary care hospitals.The prevalence of antibiotic-resistant pathogens such as MRSA,carbapenem-resistant K.pneumoniae,carbapenem-resistant P.aeruginosa,and carbapenem-resistant A.baumannii is high,which should be addressed seriously.It is urgent to promote rational use of antimicrobial agents and standardized antimicrobial therapy.