摘要
目的监测国内主要地区医疗机构临床分离菌对抗菌药物的敏感性。方法对国内主要地区51所医院临床分离菌采用纸片扩散法或自动化仪器法按CHINET统一监测方案进行抗菌药物敏感性试验。按2021年CLSI折点标准判断结果。结果收集2021年1—12月上述医院临床分离菌共301917株,其中革兰阳性菌占28.6%,革兰阴性菌占71.4%。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(除假中间葡萄球菌和施氏葡萄球菌外)中甲氧西林耐药株的检出率分别为30.0%、80.7%和77.7%。甲氧西林耐药株(MRSA、MRSE和其他MRCNS)对绝大多数抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA、MSSE和其他MSCNS)。MRSA中有92.4%的菌株对甲氧苄啶-磺胺甲唑敏感;MRSE中有90.7%的菌株对利福平敏感;未发现万古霉素耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠球菌,两者均有少数万古霉素耐药株。2021年儿童和成人中分离的非脑膜炎肺炎链球菌中PSSP的检出率分别为97.8%和95.1%。除肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为20.8%和21.9%外,肠杆菌目细菌对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于13%。2005—2021年17年的监测显示,肺炎克雷伯菌对亚胺培南和美罗培南的耐药率从2005年的3.0%和2.9%持续上升至2018年的25.0%和26.3%,但从2019年开始呈连续下降趋势。此外,不动杆菌属对亚胺培南和美罗培南的耐药率分别为65.6%和66.5%;铜绿假单胞菌对上述两药的耐药率分别为23.0%和18.9%。结论临床分离菌对常见抗菌药物的耐药率虽仍呈增长趋势,但碳青霉烯类耐药肺炎克雷伯菌和铜绿假单胞菌等多种重要的碳青霉烯类耐药细菌的检出率在多年升高变迁的情况下近年来呈现连续下降趋势,提示加强细菌耐药监测,开展多学科联动的方式对控制耐药细菌的流行播散是行之有效的。
Objective To investigate the susceptibility and resistance of clinical isolates collected from hospitals in several regions of China.Methods These clinical strains were collected from 51 hospitals.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2021 breakpoints.Results A total of 301917 clinical isolates were collected from January to December 2021,of which gram negative organisms and gram positive cocci accounted for 71.4%and 28.6%respectively.Methicillin-resistant strains in S.aureus(MRSA),S.epidermidis and other Staphylococcus species(except S.pseudintermedius and S.schleiferi)accounted for 30.0%,80.7%and 77.7%respectively.MR strains showed much higher resistance rates to most of other antimicrobial agents than MS strains.However,92.4%of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 90.7%of MRSE strains were susceptible to rifampin.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.A few strains of both Enterococcus species were resistant to vancomycin.The prevalence of PSSP was 97.8%in the non-meningitis S.pneumoniae isolates from children and 95.1%in the non-meningitis S.pneumoniae isolates from adults.The Enterobacterales strains were still highly susceptible to carbapenems.Overall,less than 13%of these strains were resistant to carbapenems.K.pneumoniae isolates showed increasing resistance rates to imipenem and meropenem,from 3.0%and 2.9%in 2005 to 25.0%and 26.3%in 2018.However,the resistance rates of Klebsiella pneumoniae to imipenem and meropenem decreased since 2019.About 65.6%and 66.5%of Acinetobacter spp.were resistant to imipenem and meropenem,respectively.Overall,23.0%and 18.9%of the Pseudomonas aeruginosa isolates were resistant to imipenem and meropenem,respectively.Conclusions Bacterial resistance to commonly used antibiotics is still on the rise.However,the prevalence of carbapenem-resistant K.pneumoniae and P.aeruginosa is decreasing in recent years.It is suggested that strengthening the monitoring of bacterial resistance and multidisciplinary teamwork are effective in controlling the spread of drug-resistant bacteria.
作者
胡付品
郭燕
朱德妹
汪复
蒋晓飞
徐英春
张小江
张朝霞
季萍
谢轶
康梅
王传清
王爱敏
徐元宏
黄颖
孙自镛
陈中举
倪语星
孙景勇
褚云卓
田素飞
胡志东
李金
俞云松
林洁
单斌
杜艳
郭素芳
魏莲花
邹凤梅
张泓
王春
胡云建
艾效曼
卓超
苏丹虹
郭大文
赵金英
喻华
黄湘宁
刘文恩
李艳明
金炎
邵春红
徐雪松
鄢超
王山梅
楚亚菲
张利侠
马娟
周树平
周艳
朱镭
孟晋华
董方
吕志勇
胡芳芳
沈瀚
周万青
贾伟
李刚
吴劲松
卢月梅
李继红
段金菊
康建邦
马晓波
郑燕萍
郭如意
朱焱
陈运生
孟青
王世富
胡雪飞
沈继录
汪瑞忠
房华
俞碧霞
赵勇
龚萍
温开镇
张贻荣
刘江山
廖龙凤
顾洪芹
姜琳
贺雯
薛顺虹
冯佼
岳春雷
HU Fupin;GUO Yan;ZHU Demei;WANG Fu;JIANG Xiaofei;XU Yingchun;ZHANG Xiaojiang;ZHANG Zhaoxia;JI Ping;XIE Yi;KANG Mei;WANG Chuanqing;WANG Aimin;XU Yuanhong;HUANG Ying;SUN Ziyong;CHEN Zhongju;NI Yuxing;SUN Jingyong;CHU Yunzhuo;TIAN Sufei;HU Zhidong;LI Jin;YU Yunsong;LIN Jie;SHAN Bin;DU Yan;GUO Sufang;WEI Lianhua;ZOU Fengmei;ZHANG Hong;WANG Chun;HU Yunjian;AI Xiaoman;ZHUO Chao;SU Danhong;GUO Dawen;ZHAO Jinying;YU Hua;HUANG Xiangning;LIU Wen’en;LI Yanming;JIN Yan;SHAO Chunhong;XU Xuesong;YAN Chao;WANG Shanmei;CHU Yafei;ZHANG Lixia;MA Juan;ZHOU Shuping;ZHOU Yan;ZHU Lei;MENG Jinhua;DONG Fang;L Zhiyong;HU Fangfang;SHEN Han;ZHOU Wanqing;JIA Wei;LI Gang;WU Jinsong;LU Yuemei;LI Jihong;DUAN Jinju;KANG Jianbang;MA Xiaobo;ZHENG Yanping;GUO Ruyi;ZHU Yan;CHEN Yunsheng;MENG Qing;WANG Shifu;HU Xuefei;SHEN Jilu;WANG Ruizhong;FANG Hua;YU Bixia;ZHAO Yong;GONG Ping;WENG Kaizhen;ZHANG Yirong;LIU Jiangshan;LIAO Longfeng;GU Hongqin;JIANG Lin;HE Wen;XUE Shunhong;FENG Jiao;YUE Chunlei(Institute of Antibiotics,Huashan Hospital,Fudan University,Key Laboratory of Clinical Pharmacology of Antibiotics,National Health Commission,Shanghai 200040,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2022年第5期521-530,共10页
Chinese Journal of Infection and Chemotherapy
基金
CHINET中国细菌耐药监测网基金(2020QD049)。