2021年CHINET中国细菌耐药监测

CHINET surveillance of antimicrobial resistance among the bacterial isolates in 2021

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.