中国细菌耐药监测研究(CARST)2021—2022年革兰氏阳性菌监测报告

Antimicrobial susceptibility of Gram-positive organisms:Resultss from China antimicrobial resistance surveillance trial(CARST)program,2021-2022

目的监测我国主要城市三级甲等医院住院患者分离革兰氏阳性菌的耐药状况,掌握耐药流行趋势,为抗菌药物合理使用提供科学依据。方法定点收集来自全国19家医院的临床分离细菌,由中心实验室统一采用平皿/肉汤二倍稀释法测定抗菌药物的最低抑菌浓度(MIC)值。结果对2021年7月至2022年6月来自全国19座城市19家医院的1974株临床分离致病菌进行了MIC测定。结果显示,甲氧西林耐药金黄色葡萄球菌(MRSA)和甲氧西林耐药表皮葡萄球菌(MRSE)检出率分别为36.4%和79.9%。未发现万古霉素不敏感葡萄球菌,金黄色葡萄球菌对利奈唑胺、替考拉宁100%敏感。粪肠球菌、屎肠球菌对氨苄西林的耐药率分别为3.1%和92.9%。万古霉素耐药肠球菌(VRE)检出率为1.6%,利奈唑胺不敏感粪肠球菌比例为32.2%,连续2次监测上升;利奈唑胺不敏感屎肠球菌比例(12.5%)亦明显升高。青霉素不敏感肺炎链球菌(PNSSP)检出率按非脑膜炎、非肠道系统给药折点计算为0.8%,较前次监测下降近30个百分点,而按口服青霉素V折点计算为71.8%,较之前变化不大,提示青霉素MIC值较高(MIC≥4 mg·L^(-1))菌株数量显著减少。不同病房、不同年龄以及不同标本来源金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、屎肠球菌耐药率比较均无显著性差异。结论VRE检出率稳定在低水平;青霉素MIC值较高的肺炎链球菌较前次监测明显减少;利奈唑胺不敏感肠球菌明显增加,值得注意。

Objective To investigate the Gram-positive coccus resistance in nationwide’s tertiary hospitals and understand the trend of antimicrobial resistance.Methods All the clinical isolates were collected from 19 hospitals and the minimal inhibitory concentrations(MICs)were tested using agar/broth dilution method recommended.Results A total of 1974 pathogenic Gram-positive coccus from 19tertiary hospitals in 19 cities nationwide over the period from July 2021 to June 2022 were studied.Based on the MIC results,the prevalence of methicillin resistantStapylococcus aureus(MRSA)and methicillin resistantStapylococcus epidermidis(MRSE)were 36.4%and 79.9%respectively.No vancomycin insensitivityStaphylococcuswas detected.Staphylococcus aureuswere 100%susceptibility to linezolid and teicoplanin.Antibiotic resistance rate ofEnterococcus faecalisand Enterococcus faeciumto ampicillin were 3.1%and 92.9%.The detectation rate of vancomycin resistantEnterococcus(VRE)was 1.6%.Nonsusceptibility rate of Enterococcus faecalisto linezolid was 32.2%,two consecutive monitoring rises and nonsusceptibility rate of Enterococcus faecium(12.5%)was also significantly increased.The prevalence of penicillin non-susceptible Streptococcus pneumoniae(PNSSP)was 0.8%based on non-meningitis and parenteral administration criterion,decrease of nearly 30 percentage points from the previous surveillance.While for cases of oral penicillin,the rate was 71.8%,showing similar to last time.The results indicated that the number of strains with higher MIC value of penicillin(MIC≥4 mg·L^(-1))decreased significantly.There were no significant differences of resistance rates of Stapylococcus aureus,Stapylococcus epidermidis,Enterococcus faecalis,Enterococcus faeciumand Streptococcus pneumoniaeamong various groups such as different department,age,or specimen source.Conclusion VRE detection ratio stablized at a relatively low level.The number of Streptococcus pneumoniaewith higher MIC value of penicillin decreased significantly compared with the previous monitoring.The increase of linezolidin-insensitive Enterococcuswas noteworthy.