2007－2013年医院内获得性肺炎病原菌分布及其耐药性分析

Abstract

目的：调查随着时间推移中国医院内获得性肺炎（HAP）病原谱变迁；分析 HAP的常见细菌对抗菌药物的敏感性的变化。方法收集2007－2013年全国13所教学医院H A P患者标本的非重复病原菌，菌株经中心实验室复核后，测定常用抗菌药物的最低抑菌浓度，进行耐药性分析。结果 HAP前5位病原菌依次为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌和大肠埃希菌；鲍氏不动杆菌的发生率逐年升高，从2007年的17．4％上升至2013年的35．8％，铜绿假单胞菌的发生率有所下降，从2007年的23．4％下降至2013年的16．9％；鲍氏不动杆菌对多黏菌素B （97．4％～100．0％）和替加环素（79．8％～90．2％）保持很高的体外敏感性；多药耐药的鲍氏不动杆菌呈现逐年上升的趋势。从2007年的53．3％上升至2013年的77．1％；碳青霉烯类耐药的肠杆菌科细菌有增长趋势，铜绿假单胞菌敏感的抗菌药物依次为多黏菌素B （93．1％～100．0％）、阿米卡星（68．6％～88．7％）、哌拉西林／他唑巴坦（69．6％～83．2％）、头孢他啶（61．8％～77．2％）、美罗培南（57．7％～73．2％）；多药耐药的铜绿假单胞菌呈现逐年下降的趋势，从2007年的23％下降至2013年的10．3％；肺炎克雷伯菌敏感的抗菌药物依次为美罗培南（93．3％～100．0％）、亚胺培南（93．3％～100．0％）、替加环素（92．2％～99．2％）、哌拉西林／他唑巴坦（79．2％～90．4％）、阿米卡星（75．0％～99．0％）；肺炎克雷伯菌ESBLs的发生率也呈现逐年下降的趋势，从2007年的52．9％下降至2013年的28．1％；金黄色葡萄球菌未出现对万古霉素、替考拉宁、利奈唑胺耐药的菌株，甲氧西林耐药的金黄色葡萄球菌（M RS A ）的发生率呈现逐年下降的趋势，从2007年的87．1％下降至2013年的54．4％；大肠埃希菌敏感的抗菌药物依次为替加环素（100．0％）、美罗培南（97．1％～100．0％）、亚胺培南（94．3％～100．0％）、哌拉西林／他唑巴坦（82．9％～100．0％）、阿米卡星（78．6％～94．7％）；大肠埃希菌ESBLs的发生率呈现逐年下降的趋势，从2007年的84．1％下降至2013年的51．4％。结论鲍氏不动杆菌取代铜绿假单胞菌成为HAP第1位病原菌，多药耐药鲍氏不动杆菌呈现明显上升趋势，碳青霉烯类耐药的肠杆菌科细菌略有上升，而医院内其他常见多药耐药细菌MRSA、产ESBLs的大肠埃希菌和肺炎克雷伯菌、多药耐药铜绿假单胞菌呈现下降趋势，需要进一步监测。

OBJECTIVE To investigate the change of spectrum of pathogens causing hospital‐acquired pneumonia (HAP) in China as time goes and analyze the change of drug susceptibility of common species of pathogens causing HAP .METHODS The non‐repetitive pathogens were isolated from species of patients with HAP who were treated in 13 teaching hospitals in China from 2007 to 2013 ,the minimum inhibitory concentrations of the commonly used antibiotics were determined after the strains were reexamined by central laboratories ,and the drug resistance was analyzed .RESULTS The top 5 species of pathogens causing HAP were in turn as follows :Acinetobacter bauman‐nii ,Pseudomonas aeruginosa ,Klebsiella pneumoniae ,Staphylococcus aureus ,and Escherichia coli .The inci‐dence of A .baumannii was increased year by year ,increasing from 17 .4% in 2007 to 35 .8% in 2013 ;the inci‐dence of P .aeruginosa was decreased ,decreasing from 23 .4% in 2007 to 16 .9% in 2013 .The A .baumannii strains maintained high in vitro susceptibility against polymyxin B (97 .4% ~ 100 .0% ) and tigecycline (79 .8% ~90 .2% ) .The isolation rate of multidrug‐resistant A .baumannii was increased year by year ,increasing from 53 .3% in 2007 to 77 .1% in 2013 .The isolation rate of carbapenem‐resistant Enterobacteriaceae showed an upward trend .The P .aeruginosa strains were susceptible to the following antibiotics :polymyxin (93 .1% ~100 .0% ) ,amikacin (68 .6% ~ 88 .7% ) ,piperacillin‐tazobactam (69 .6% ~ 83 .2% ) ,ceftazidime (61 .8% ~77 .2% ) ,meropenem (57 .7% ~73 .2% ) .The isolation rate of multidrug‐resistant P .aeruginosa showed a down‐ward trend ,decreasing from 23 .0% in 2007 to 10 .3% in 2013 .The K .pneumoniae strains were susceptible to the following antibiotics :meropenem (93 .3% ~ 100 .0% ) ,imipenem (93 .3% ~ 100 .0% ) ,tigecycline (92 .2% ~99 .2% ) ,piperacillin‐tazobactam (79 .2% ~90 .4% ) ,amikacin (75 .0% ~99 .0% ) .The incidence of ESBLs‐pro‐ducing K .pneumoniae strains was decreased year by year ,decreasing from 52 .9% in 2007 to 28 .1% in 2013 .The S .aureus strains that were resistant to vancomycin ,teicoplanin ,or linezolid were not found .The incidence of me‐thicillin‐resistant S .aureus (MRSA) was decreased year by year ,decreasing from 87 .1% to 54 .4% in 2013 .The E .coli strains were susceptible to the following antibiotics :tigecycline (100 .0% ) , meropenem (97 .1% ~100 .0% ) ,imipenem (94 .3% ~ 100 .0% ) , piperacillin‐tazobactam (82 .9% ~ 100 .0% ) , amikacin (78 .6% ~94 .7% ) .The incidence of ESBLs‐producing E .coli strains was decreased year by year ,decreasing from 84 .1% in 2007 to 51 .4% in 2013 .CONCLUSION A .baumannii has ranked the first place of pathogens causing HAP by re‐placing P .aeruginosa .The prevalence of multidrug‐resistant A .baumannii is increased dramatically .The preva‐lence of carbapenem‐resistant Enterobacteriaceae is increased slightly .The prevalence of other multidrug‐resistant bacteria MRSA ,ESBLs‐producing E .coli and K .pneumoniae ,or multidrug‐resistant P .aeruginosa shows a downward trend ,which should be further monitored .