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2016年中国CHINET细菌耐药性监测

CHINET surveillance of bacterial resistance across China:report of the results in 2016

【作者】 胡付品郭燕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郭素芳魏莲花邹凤梅张泓王春胡云建艾效曼卓超苏丹虹汪瑞忠房华俞碧霞赵勇龚萍郭大文赵金英刘文恩李艳明金炎邵春红温开镇张贻荣徐雪松鄢超喻华黄湘宁王山梅楚亚菲张利侠马娟周树平周艳朱镭孟晋华

【Author】 HU Fupin;GUO Yan;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;GUO Sufang;WEI Lianhua;ZOU Fengmei;ZHANG Hong;WANG Chun;HU Yunjian;AI Xiaoman;ZHUO Chao;SU Danhong;WANG Ruizhong;FANG Hua;YU Bixia;ZHAO Yong;GONG Ping;GUO Dawen;ZHAO Jinying;LIU Wenen;LI Yanming;JIN Yan;SHAO Chunhong;WEN Kaizhen;ZHANG Yirong;XU Xuesong;YAN Chao;YU Hua;HUANG Xiangning;WANG Shanmei;CHU Yafei;ZHANG Lixia;MA Juan;ZHOU Shuping;ZHOU Yan;ZHU Lei;MENG Jinhua;Institute of Antibiotics, Huashan Hospital, Fudan University;

【机构】 复旦大学附属华山医院抗生素研究所复旦大学附属华山医院抗生素研究所检验科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,上海市儿童医院北京医院广州医科大学附属第一医院上海市浦东新区人民医院宁波市镇海龙赛医院湖北省秭归县人民医院哈尔滨医科大学附属第一医院中南大学湘雅医院山东省立医院福建省晋江医院吉林大学中日联谊医院四川省人民医院河南省人民医院陕西省人民医院江西省儿童医院山西省儿童医院

【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。方法对国内主要地区30所教学医院(26所综合性医院、4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抗菌药物敏感性试验。按CLSI 2016版判断结果。结果收集2016年1-12月上述医院临床分离菌共153 059株,其中革兰阳性菌43 462株,占28.4%,革兰阴性菌109 597株,占71.6%。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38.4%和77.6%。甲氧西林耐药株(MRSA和MRCNS)对绝大多数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92.3%菌株对甲氧苄啶-磺胺甲唑敏感;MRCNS中有86.5%菌株对利福平敏感;未发现万古霉素和替考拉宁耐药菌株。肠球菌属中粪肠球菌对多数测试抗菌药物(氯霉素除外)的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株,经表型或基因型检测结果显示主要为Van A型、Van B型或Van M型耐药。儿童肺炎链球菌非脑膜炎分离株中青霉素敏感和中介(PSSP和PISP)株所占比例较2015年有所上升,青霉素耐药(PRSP)株的检出率有所下降;成人分离株中PISP和PRSP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ESBL率分别平均为45.2%、25.2%和16.5%,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,多数菌属的耐药率低于10%。不动杆菌属(鲍曼不动杆菌占90.6%)对亚胺培南和美罗培南的耐药率分别为68.6%和71.4%。与2015年耐药率数据相比,铜绿假单胞菌中广泛耐药株的检出率有所上升。结论临床分离菌对常用抗菌药物的耐药率仍呈增长趋势,应加强医院感染防控措施和抗菌药物临床应用管理措施,继续做好细菌耐药性监测工作。

【Abstract】 Objective To investigate the susceptibility profile of clinical isolates collected from hospitals across China. Methods Twenty-six general hospitals and four 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 2016 breakpoints. Results A total of 153 059 clinical isolates were collected from Junuary to December 2016, of which gram-negative organisms and gram-positive cocci accounted for 71.6% and 28.4%, respectively. The overall prevalence of methicillin-resistant strains was 38.4% in S. aureus(MRSA) and 77.6% in coagulase negative staphylococcus(MRCNS), respectively. The resistance rates of methicillin-resistant strains to most of other antimicrobial agents were much higher than those of methicillin-susceptible strains. However, 92.3% of the MRSA strains were still sensitive to trimethoprim-sulfamethoxazole, while 86.5% of the MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin or teicoplanin. The resistance rates of E. faecalis strains to most drugs tested(except chloramphenicol) were much lower than those of E. faecium. A few strains of both species were resistant to vancomycin. Vancomycin resistant E. faecalis and E. faecium strains were mainly Van A, Van B or Van M type based on their phenotype or genotype. Regarding the non-meningitis S. pneumoniae strains, the prevalence of PSSP or PISP strains isolated from children was higher than that isolated in 2015, but the prevalence of PRSP strains decreased. However, the prevalence of PISP and PRSP strains isolated from adults was lower than that isolated in 2015. The prevalence of ESBLs-producing strains was 45.2% in E. coli, 25.2% in Klebsiella spp.(K. pneumoniae and K. oxytoca) and 16.5% in Proteus mirabilis isolates on average. ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rate. The strains of Enterobacteriaceae were still highly susceptible to carbapenems. Overall, less than 10% of these strains were resistant to carbapenems. About 68.6% and 71.4% of Acinetobacter spp.(A. baumannii accounts for 90.6%) strains were resistant to imipenem and meropenem, respectively. The prevalence of extensively-drug resistant strains in P. aeruginosa was higher than that in 2015. Conclusions Bacterial resistance to commonly used antibiotics is still on the rise. It is necessary to strengthen hospital infection control and management of clinical use of antimicrobial agents, and maintain good practice in surveillance of bacterial resistance.

【关键词】 细菌耐药性监测; 药物敏感性试验; 广泛耐药菌; 万古霉素耐药肠球菌; 甲氧西林耐药葡萄球菌; 青霉素耐药肺炎链球菌; 碳青霉烯类耐药革兰阴性菌;

【Key words】 bacterial resistance surveillance; antimicrobial susceptibility testing; extensively-drug resistant bacterium; vancomycin-resistant Enterococcus; methicillin-resistant Staphylococcus; penicillin-resistant Streptococcus pneumoniae; carbapenem-resistant gram-negative bacterium;

【分类号】R915.13;R962;R978.1;

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