2018至2019年度全国血流感染细菌耐药监测报告

BRICS report of 2018-2019:the distribution and antimicrobial resistance profile of clinical isolates from blood culture in China

目的通过研究血流感染的病原菌分布及对其耐药性监测,准确掌握我国细菌耐药状况。方法收集全国血流感染细菌耐药监测联盟成员单位2018年1月至2019年12月所有按操作规程分离自血培养的感染病原菌,按美国临床和实验室标准化研究所推荐的琼脂稀释法或肉汤稀释法进行抗菌药物药敏性测定。采用WHONET5.6进行统计分析。结果2018年1月至2019年12月共收集50家成员单位14778株病原菌,其中革兰阳性菌为4117株(27.9%),革兰阴性菌10661株(72.1%)。最常见的前10位病原菌为大肠埃希菌5500株(37.2%)、肺炎克雷伯菌2519株(17.0%)、金黄色葡萄球菌1438株(9.7%)、凝固酶阴性葡萄球菌1285株(8.7%)、铜绿假单胞菌546株(3.7%)、屎肠球菌504株(3.4%)、鲍曼不动杆菌501株(3.4%)、阴沟肠杆菌424株(2.9%)、其他链球菌属414株(2.8%)和粪肠球菌344株(2.3%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌检出率分别为27.4%(394/1438)和70.4%(905/1285),未检测到对糖肽类耐药的葡萄球菌;金黄色葡萄球菌对阿米卡星、利福平和复方磺胺甲噁唑的敏感率均在95%以上。屎肠球菌对万古霉素的耐药率为0.4%(2/504),未检测到耐万古霉素的粪肠球菌。产超广谱β-内酰胺酶非耐碳青霉烯类大肠埃希菌、碳青霉烯敏感肺炎克雷伯菌、变形杆菌属分别为50.4%(2731/5415)、24.6%(493/2001)、35.2%(31/88);耐碳青霉烯类大肠埃希菌、肺炎克雷伯菌分别为1.5%(85/5500)、20.6%(518/2519);碳青霉烯类耐药肺炎克雷伯菌对头孢他啶/阿维巴坦的耐药率为8.3%(27/325)。鲍曼不动杆菌对多黏菌素B和替加环素的耐药率分别为2.8%(14/501)和3.4%(17/501);铜绿假单胞菌对碳青霉烯类的耐药率为18.9%(103/546)。结论我国血流感染病原体以革兰阴性菌为主,大肠埃希菌为最常见的病原菌,产超广谱β-内酰胺酶为主要耐药现象;MRSA的检出率显著降低;耐碳青霉烯大肠埃希菌处于较低水平,耐碳青霉烯肺炎克雷伯菌仍呈上升趋势。

Objective To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System(BRICS)were collected during January 2018 to December 2019.Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute(CLSI).WHONET 5.6 was used to analyze data.Results During the study period,14778 bacterial strains were collected from 50 hospitals,of which 4117(27.9%)were Gram-positive bacteria and 10661(72.1%)were Gram-negative bacteria.The top 10 bacterial species were Escherichia coli(37.2%),Klebsiella pneumoniae(17.0%),Staphylococcus aureus(9.7%),coagulase-negative Staphylococci(8.7%),Pseudomonas aeruginosa(3.7%),Enterococcus faecium(3.4%),Acinetobacter baumannii(3.4%),Enterobacter cloacae(2.9%),Streptococci(2.8%)and Enterococcus faecalis(2.3%).The the prevalence of methicillin-resistant S.aureus(MRSA)and methicillin-resistant coagulase-negative Staphylococcus were 27.4%(394/1438)and 70.4%(905/1285),respectively.No glycopeptide-resistant Staphylococcus was detected.More than 95%of S.aureus were sensitive to amikacin,rifampicin and SMZco.The resistance rate of E.faecium to vancomycin was 0.4%(2/504),and no vancomycin-resistant E.faecalis was detected.The ESBLs-producing rates in no carbapenem-resistance E.coli,carbapenem sensitive K.pneumoniae and Proteus were 50.4%(2731/5415),24.6%(493/2001)and 35.2%(31/88),respectively.The prevalence of carbapenem-resistance in E.coli and K.pneumoniae were 1.5%(85/5500),20.6%(518/2519),respectively.8.3%(27/325)of carbapenem-resistance K.pneumoniae was resistant to ceftazidime/avibactam combination.The resistance rates of A.baumannii to polymyxin and tigecycline were 2.8%(14/501)and 3.4%(17/501)respectively,and that of P.aeruginosa to carbapenem were 18.9%(103/546).Conclusions The surveillance results from 2018 to 2019 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria,while E.coli was the most common pathogen,and ESBLs-producing strains were in majority;the MRSA incidence is getting lower in China;carbapenem-resistant E.coli keeps at a low level,while carbapenem-resistant K.pneumoniae is on the rise obviously.