全国血流感染细菌耐药监测(BRICS)2021年度报告

BRICS report of 2021:The distribution and antimicrobial resistance profile of clinical bacterial isolates from blood stream infections in China

目的通过血流感染病原菌谱及其耐药性的监测,为临床血流感染治疗和合理用药提供参考。方法收集全国血流感染细菌耐药监测联盟(BRICS)成员单位2021年1至12月所有分离自血培养的病原菌,按美国临床和实验室标准化研究所(CLSI)推荐的稀释法进行抗菌药物敏感性测定。采用WHONET 5.6进行分析统计。结果共收集51家成员单位11013株病原菌,其中革兰阳性菌为2782株(25.3%),革兰阴性菌8231株(74.7%)。前10位病原菌为大肠埃希菌4141株(37.6%)、肺炎克雷伯菌2076株(18.9%)、金黄色葡萄球菌1078株(9.8%)、凝固酶阴性葡萄球菌697株(6.3%)、铜绿假单胞菌401株(3.6%)、屎肠球菌397株(3.6%)、鲍曼不动杆菌308株(2.8%)、粪肠球菌296株(2.7%)、阴沟肠杆菌276株(2.5%)和其他克雷伯菌属233株(2.1%)。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流行率分别为25.3%和76.8%,未检测到对糖肽类和达托霉素耐药葡萄球菌属;金黄色葡萄球菌对头孢比罗的敏感率>95.0%。未检测到耐万古霉素肠球菌。产超广谱β-内酰胺酶大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌分别为49.6%、25.5%和39.0%;耐碳青霉烯类大肠埃希菌、肺炎克雷伯菌分别为2.2%和15.8%;7.9%耐碳青霉烯类肺炎克雷伯菌对头孢他啶/阿维巴坦耐药。头孢比罗对超广谱β-内酰胺酶阴性大肠埃希菌和肺炎克雷伯菌具有较强的抗菌活性。耐碳青霉烯类大肠埃希菌、肺炎克雷伯菌对氨曲南/阿维巴坦敏感性较高。鲍曼不动杆菌对碳青霉烯类的耐药率为60.0%,对多黏菌素B和替加环素耐药率低,分别为5.5%和4.5%;铜绿假单胞菌对碳青霉烯类的耐药率为18.9%。结论我国血流感染病原体以革兰阴性菌为主,且大肠埃希菌占1/3;MRSA的流行率呈进一步下降趋势,耐万古霉素肠球菌仍然处于较低水平;耐碳青霉烯肺炎克雷伯菌仍呈较高水平流行,但已有下降趋势,耐碳青霉烯类大肠埃希菌处于较低水平流行。

Objective To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical bacterial isolates from bloodstream infections in China in 2021.Methods The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System(BRICS)were collected during January 2021 to December 2021.Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute(CLSI).WHONET 5.6 was used to analyze data.Results During the study period,11013 bacterial strains were collected from 51 hospitals,of which 2782(25.3%)were Gram-positive bacteria and 8231(74.7%)were Gram-negative bacteria.The top 10 bacterial species were Escherichia coli(37.6%),Klebsiella pneumoniae(18.9%),Staphylococcus aureus(9.8%),coagulase-negative Staphylococci(6.3%),Pseudomonas aeruginosa(3.6%),Enterococcus faecium(3.6%),Acinetobacter baumannii(2.8%),Enterococcus faecalis(2.7%),Enterobacter cloacae(2.5%)and Klebsiella spp(2.1%).The prevalence of methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant coagulase-negative Staphylococcus aureus were 25.3%and 76.8%,respectively.No glycopeptide-and daptomycin-resistant Staphylococci was detected;more than 95.0%of Staphylococcus aureus were sensitive to ceftobiprole.No vancomycin-resistant Enterococci strains were detected.The rates of extended spectrum B-lactamase(ESBL)-producing isolated in Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis were 49.6%,25.5%and 39.0%,respectively.The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.2%and 15.8%,respectively;7.9%of carbapenem-resistant Klebsiella pneumoniae was resistant to ceftazidime/avibactam combination.Ceftobiprole demonstrated excellent activity against non-ESBL-producing Escherichia coli and Klebsiella pneumoniae.Aztreonam/avibactam was highly active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae.The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%,while polymyxin and tigecycline showed good activity against Acinetobacter baumannii(5.5%and 4.5%).The prevalence of carbapenem-resistance in Pseudomonas aeruginosa was 18.9%.Conclusions The BRICS surveillance results in 2021 shows that the main pathogens of blood stream infection in China are gram-negative bacteria,in which Escherichia coli is the most common.The MRSA incidence shows a further decreasing trend in China and the overall prevalence of vancomycin-resistant Enterococci is low.The prevalence of Carbapenem-resistant Klebsiella pneumoniae is still on a high level,but the trend is downwards.