中国细菌耐药监测研究2017-2018革兰氏阴性菌监测报告

Abstract

目的监测我国主要城市三级甲等医院住院患者的细菌耐药状况,掌握耐药流行趋势,为抗生素合理使用提供科学数据。方法定点收集来自全国19家医院临床分离致病菌,由中心实验室统一用平皿/肉汤二倍稀释法测定抗菌药物最低抑菌浓度(MIC)值,参照美国临床和实验室标准协会(CLSI)或欧洲抗菌药物敏感性试验委员会(EUCAST) 2019年标准判定细菌敏感、耐药率。结果对来自全国19座城市19家三级甲等医院的4602株临床分离革兰氏阴性致病菌进行了MIC测定。结果显示,大肠埃希菌和肺炎克雷伯菌中超广谱β内酰胺酶(ESBLs)表型检出率分别为54. 6%和28. 1%,大肠埃希菌较前次下降约5个百分点,肺炎克雷伯菌持平。对肠杆菌科细菌抗菌作用较好的药物包括碳青霉烯类、阿米卡星、拉氧头孢、β内酰胺类合剂、替加环素、磷霉素氨丁三醇等,但碳青霉烯类耐药肺炎克雷伯菌比例继续增加。非发酵革兰氏阴性菌中铜绿假单胞菌和鲍曼不动杆菌对亚安培南的耐药率分别为29. 7%和71. 4%,多重耐药菌(MDR)检出率分别为31. 8%和75. 1%,泛耐药菌(XDR)检出率分别为9. 1%和69. 9%。不同病房、不同年龄以及不同标本来源菌株耐药率比较提示,儿童患者分离菌中肺炎克雷伯菌对β内酰胺类等药物耐药率显著高于成年人与老年人,我国儿童中细菌耐药问题不容忽视。结论大肠埃希菌ESBLs检出率有所下降;碳青霉烯类耐药肺炎克雷伯菌有继续增加趋势;多黏菌素E耐药肺炎克雷伯菌增加明显,值得注意。

Objective To investigate the antibacterial resistance in nationwide's tietiary 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 by Clinical and Laboratory Standards Institute( CLSI) in central laboratory. The susceptibilities of isolates to antimicrobial agents were determined by using CLSI or European Committee on Antimicrobial Susceptibility Testing( EUCAST) 2019 guideline. Results A total of 4602 pathogenic isolates from 19 tertiary hospitals in 19 cities nationwide over the period from July 2017 to June2018 were studied. Based on the MIC results,Escherichia coli and Klebsiella pneumoniae showed extended spectrum β-lactamase( ESBLs)phenotype rates of 54. 6% and 28. 1%, respectively; decreased by5 percentage points for Escherichia coli comparing the last time and stablized for Klebsiella pneumoniae. Carbapenems,amikacin,moxalactam,β-lactam combination agents,tigecycline,and fosfomycin trometamol displayed desirable antibacterial activity against Enterbacteriaceae,but a continuously increasing of carbapenems resistance Klebsiella pneumoniae were noted. For non-fermenting Gram-negative isolates,resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannnii to imipennnem were 29. 7% and 71. 4% and multidrug-resistant( MDR) detection rate were 31. 8% and 75. 1%,extensively drug-resistant( MDR) were 9. 1% and 69. 9%,respectively. Klebsiella pneumoniae isolated from children were more resistance to β-lactam than those from adults and the old people,so bacterial resistance in children is an important problem in China. Conclusion Though the decline of ESBLs detection rate for Escherichia coli,carbapenem resistance Klebsiella pneumoniae rates continued to increase and colistin resistance Klebsiella pneumoniae significant rising,which should be paid more attention.