2015—2021年CHINET临床分离铜绿假单胞菌耐药性变迁

Changing resistance profiles of Pseudomonas aeruginosa isolates in hospitals across China:results from the CHINET Antimicrobial Resistance Surveillance Program,2015-2021

目的了解2015—2021年中国主要地区临床分离铜绿假单胞菌对各类抗菌药物的耐药性变迁。方法对CHINET 51所医院临床分离铜绿假单胞菌按照CHINET技术方案采用纸片扩散法或自动化仪器法进行抗菌药物敏感性试验,按照CLSI 2021年标准判读药敏结果,并用WHONET 5.6软件进行数据分析。结果2015—2021年从51所医院临床标本中共分离到129701株铜绿假单胞菌,检出率为8.6%,历年该菌检出率在不发酵糖革兰阴性杆菌中次于不动杆菌属排第二位。其中(91.4±1.0)%菌株分离自住院患者,(66.4±2.8)%菌株分离自呼吸道分泌物。铜绿假单胞菌对各种抗菌药物耐药率均有所下降,对阿米卡星、多黏菌素及头孢他啶-阿维巴坦的敏感率>90%。分离自门急诊的菌株对各抗菌药物的耐药率在1.0%~19.8%,分离自ICU的菌株耐药率为0.6%~40.5%,分离自内科和外科的菌株耐药率分别为0.8%~28.8%和1.2%~23.3%。分离自儿童的菌株耐药率在0.8%~18.8%,成人株为1.2%~26.1%,老年株为1.0%~28.5%。二级医院、三级医院和儿童医院分离菌株的耐药率分别为2.5%~24.2%、0.7%~27.6%和0.6%~20.3%。碳青霉烯类耐药铜绿假单胞菌共35153株,检出率为27.1%。结论铜绿假单胞菌是最常检出的不发酵糖革兰阴性杆菌之一,该菌对各抗菌药物耐药率逐年下降,耐药监测是控制细菌耐药发生和发展行之有效的手段。来自不同标本类型、不同科室及患者年龄的菌株耐药性相差较大,临床中更应该加强监测,协助医师合理用药,预防和控制耐药菌的流行。

Objective To investigate the changing antimicrobial susceptibility profiles of Pseudomonas aeruginosa to various antibiotics in hospitals across China from 2015 to 2021.Methods The P.aeruginosa strains were isolated from 52 hospitals across China.Antimicrobial susceptibility testing was carried out by Kirby-Bauer method and automated systems according to the unified protocol of CHINET program.The results were interpreted according to the Clinical&Laboratory Standards Institute(CLSI)breakpoints.The data were analyzed with WHONET 5.6 software.Results A total of 129701 strains of P.aeruginosa were collected from 2015 to 2021,accounting for 8.6%of all clinical isolates.The proportion of P.aeruginosa among non�fermentative gram-negative bacilli was only secondary to the proportion of Acinetobacter spp.Majority(91.4%±1.0%)of the P.aeruginosa strains were isolated from inpatients and(66.4±2.8)%of the strains were isolated from respiratory tract secretions.P.aeruginosa strains showed decreasing resistance rates to the antimicrobial agents tested during the 7-year period.More than 90%of the P.aeruginosa strains were resistant to amikacin,polymyxins,and ceftazidime-avibactam.About 1.0%-19.8%of the P.aeruginosa strains from outpatient and emergency departments,0.6%-40.5%of the strains from ICU inpatients,0.8%-28.8%of the strains from the inpatients in internal medicine wards,and 1.2%-23.3%of the strains from the inpatients in surgery wards were resistant to the antimicrobial agents tested.About 0.8%-18.8%of the P.aeruginosa strains isolated from children,1.2%-26.1%of the strains from adult patients,and 1.0%-28.5%of the strains from the elderly patients were resistant to the antimicrobial agents tested.Overall,2.5%-24.2%,0.7%-27.6%,and 0.6%-20.3%of the P.aeruginosa strains isolated from secondary hospitals,tertiary hospitals,and children's hospitals respectively were resistant to the antimicrobial agents tested.The prevalence of carbapenem�resistant P.aeruginosa was 27.1%(35153/129701).Conclusions P.aeruginosa is one of the most common clinical isolates of non-fermentative gram-negative bacilli.P.aeruginosa isolates showed downward resistance rates to the antimicrobial agents tested during the 7-year period.Antimicrobial resistance surveillance is an effective way for controlling the emergence and development of antimicrobial resistance.The antimicrobial resistance profile of P.aeruginosa strains varied with specimen type,clinical setting,and patient age.We should strengthen antimicrobial resistance surveillance and improve rational antibiotic use to prevent and control the spread of antibiotic-resistant P.aeruginosa.