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2014年CHINET中国细菌耐药性监测

CHINET 2014 surveillance of bacterial resistance in China

【作者】 胡付品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沈继录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韩艳秋郭素芳魏莲花吴玲张泓孔菁胡云建艾效曼卓超苏丹虹

【Author】 HU Fupin;ZHU Demei;WANG Fu;JIANG Xiaofei;XU Yingchun;ZHANG Xiaojiang;ZHANG Zhaoxia;JI Ping;XIE Yi;KANG Mei;WANG Chuanqing;WANG Aimin;XU Yuanhong;SHEN Jilu;SUN Ziyong;CHEN Zhongju;NI Yuxing;SUN Jingyong;CHU Yunzhuo;TIAN Sufei;HU Zhidong;LI Jin;YU Yunsong;LIN Jie;SHAN Bin;DU Yan;HAN Yanqiu;GUO Sufang;WEI Lianhua;WU Ling;ZHANG Hong;KONG Jing;HU Yunjian;AI Xiaoman;ZHUO Chao;SU Danhong;Institute of Antibiotics,Huashan Hospital,Fudan University;

【机构】 复旦大学附属华山医院中国医学科学院北京协和医院新疆医科大学第一附属医院四川大学华西医院复旦大学附属儿科医院安徽医科大学第一附属医院华中科技大学同济医学院附属同济医院上海交通大学医学院附属瑞金医院中国医科大学附属第一医院天津医科大学总医院浙江大学医学院附属邵逸夫医院昆明医科大学第一附属医院内蒙古医科大学附属医院甘肃省人民医院上海交通大学附属儿童医院卫生部北京医院广州医科大学附属第一医院

【摘要】 目的了解国内主要地区临床分离菌对常用抗菌药物的敏感性和耐药性。方法国内主要地区17所教学医院(15所综合性医院、2所儿童医院)临床分离菌采用纸片扩散法或自动化仪器法按统一方案进行细菌药物敏感性试验。按美国临床和实验室标准化协会(CLSI)2014版标准判断结果。结果收集各医院2014年1—12月临床分离菌共78 955株,其中革兰阳性菌21 635株,占27.4%,革兰阴性菌57 320株,占72.6%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株的平均检出率分别为44.6%和83.0%。甲氧西林耐药株(MRSA和MRCNS)对β内酰胺类抗生素和其他测试药的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。MRSA中有92.0%菌株对甲氧苄啶-磺胺甲口恶唑敏感;MRCNS中有85.6%的菌株对利福平敏感。未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物(氯霉素除外)的耐药率显著低于屎肠球菌,两者中均有少数万古霉素耐药株,表型或基因型检测结果显示主要为VanA型、其次为VanB型或VanM型耐药。肺炎链球菌非脑膜炎株成人株和儿童株中青霉素敏感株(PSSP)所占比例较2013年均有所上升,中介(PISP)和耐药(PRSP)的检出率均有所下降。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中产超广谱β内酰胺酶(ESBL)株平均分别为55.8%、29.9%和24.0%,产ESBL株对测试药物的耐药率均比非产ESBL株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,绝大多数菌株的耐药率低于10%。不动杆菌属(鲍曼不动杆菌占93.0%)对亚胺培南和美罗培南的耐药率分别为62.4%和66.7%。与2013年相比,肺炎克雷伯菌和鲍曼不动杆菌中广泛耐药株的检出率有所上升。结论细菌耐药性仍呈增长趋势,多重耐药和广泛耐药菌株检出率的增加对临床抗感染治疗构成严重威胁,需及时采取有效的感控措施。

【Abstract】 Objective To investigate the susceptibility and resistance of clinical isolates from hospitals in several regions of China.Methods Fifteen general hospitals and two children′s hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2014 breakpoints.Results A total of 78 955 clinical isolates were collected from January to December 2014,of which gram negative organisms and gram positive cocci accounted for 72.6% and 27.4%,respectively.Methicillin-resistant strains in S.aureus(MRSA)and coagulase negative Staphylococcus(MRCNS)accounted for an average of44.6% and 83.0%,respectively.The resistance rates of methicillin-resistant strains toβ-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains.However,92.0% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 85.6% of MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin,teicoplanin or linezolid.In Enterococcus spp.,the resistance rates of E.faecalis strains to most tested drugs(except chloramphenicol)were much lower than those of E.faecium.Some strains of both species were resistant to vancomycin.Vancomycin resistant strains of E.faecalis and E.faecium were mainly VanA,VanB or VanM type based on their phenotype or genotype.Regarding non-meningitis S.pneumoniaestrains,the prevalence of penicillin-susceptible S.pneumoniae strains isolated from both adults and children were higher than those isolated in 2013,but the prevalence of penicillin-intermediate S.pneumoniae or penicillin-resistant S.pneumoniae strains decreased.The prevalence of ESBLs producing strains was 55.8% in E.coli and 29.9% in Klebsiella spp.(K.pneumoniae and K.oxytoca)and 24.0% in Proteus mirabilis isolates on average.ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLsproducing strains in terms of antibiotic resistance rates.The strains of Enterobacteriaceae were still highly susceptible to carbapenems.Overall less than 10 % of these strains were resistant to carbapenems.About 62.4% and 66.7% of Acinetobacter spp.(A.baumannii accounts for 93.0%)strains were resistant to imipenem and meropenem,respectively.Compared with the data of year 2013,extensively-drug resistant strains in K.pneumoniae and A.baumannii increased.Conclusions The antibiotic resistance of clinical bacterial isolates is growing.The disseminated multi-drug or pan-drug resistant strains in a special region poses a serious threat to clinical practice and implies the importance of strengthening infection control.

【关键词】 细菌耐药性监测; 药物敏感性试验; 多重耐药菌; 广泛耐药菌; 万古霉素耐药肠球菌; 耐甲氧西林葡萄球菌; 耐青霉素肺炎链球菌; 碳青霉烯酶;

【Key words】 bacterial resistance surveillance; antimicrobial susceptibility testing; multi-drug resistant bacterium; extensively-drug resistant bacillus; vancomycin-resistant Enterococcus; methicillin-resistant Staphylococcus; penicillin-resistant Streptococcus pneumoniae; carbapenemase;

【分类号】R962;R978.11;R915.13;

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