血标本来源的广泛耐药革兰阴性菌的流行病学分析  

Epidemiological study on extensively drug-resistant strains of Gram-negative bacteria from blood samples in China

作　　者：唐翔[1] 肖永红[2] 郑波[3] 徐英春[4] 徐安[1] 肖书念[1] 卓超[1] 钟南山[1] 

机构地区：[1]广州医科大学附属第一医院,呼吸疾病国家重点实验室,广州510120 [2]浙江大学附属第一医院,杭州310006 [3]北京大学第一医院,北京100034 [4]北京协和医院,北京100032

出　　处：《中国抗生素杂志》2016年第6期453-459,共7页Chinese Journal of Antibiotics

摘　　要：目的探讨血标本来源耐碳青霉烯大肠埃希菌(CREC)、肺炎克雷伯菌(CRKP),广泛耐药铜绿假单胞菌(XDRPA)、鲍曼不动杆菌(XDRAB)的地理分布和可用抗菌药物的最小抑菌浓度(MIC)分布。方法 2013年国内主要地区208所综合医院收集来自血标本大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌临床分离株共24113株。采用自动化仪器法检测抗菌药物MIC。统计分析4种耐药株检出率与地理分布、临床科室来源、不同年龄组人群来源相关性。结果 CREC、CRKP、XDRPA和XDRAB平均检出率分别为1.0%,5.5%,4.2%和13.7%。除CREC,余耐药菌地理区域差异性明显。儿童CRKP和XDRAB检出率最高,分别为10.6%和13.1%。ICU科室各菌株检出率均较高。55.8%CREC和22.9%CRKP亚胺培南MIC值≤4μg/m L,97.4%的XDRAB和84%的XDRPA为对亚胺培南MIC≥16μg/m L。所有CREC,CRKP和81.2%的XDRAB对替加环素敏感,其MIC90分别为0.5,2和4μg/m L。结论我国血标本来源的CRKP和XDRAB在各地均有检出,尤以儿童组和ICU科室较明显。替加环素对CRKP,CRE和XDRAB保持较高敏感性。Objective To investigate the geographic and clinical distributions and the minimum inhibitory concentrations （MICs） of carbapenem-resistant Escherichia coli（CREC）, carbapenem-resistant Klebsiella pneumoniae （CRKP）, extensively drug-resistant strains of Pseudomonas aeruginosa （XDRPA） and Acinetobacter baumannii （XDRAB） from blood specimens. Methods 24,113 isolates including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, were collected from blood cultures by 208 general hospitals located in seven administrative regions of China in 2013. Minimum inhibitory concentrations （MICs） for common antimicrobials were determined by automated systems available at local hospitals, and the detection rate of CREC, CRKP, XDRPA and XDRAB from different geographic distribution, clinical departments and age groups were also analyzed. Results The average prevalence of CREC, CRKP, XDRAB and XDRPA strains was 1.0%, 5.5%, 13.7% and 4.2%, respectively. Except for CREC which did not differ greatly by region, the prevalence of the remaining three kinds of strains varied significantly across the regions. The highest prevalence of CRKP （10.6%） and XDRAB （13.1%） were found in the pediatric group, and higher prevalence of all four target strains was found in ICU. For imipenem, 55.8% of CREC and 22.9% of CRKP strains had MICs of ≤4μg/mL, while 97.4% XDRAB and 84% XDRPA isolates had the MICs of ≥ 16μg/mL. All CREC, CRKP, and 81.2% of XDRAB strains were susceptible to tigecycline, with MIC90 of 0.5, 2 and 4μg/mL, respectively. Conelusion A high prevalence of CRKP and XDRAB emerged in China, especially in pediatric patients and in the ICU. Tigecycline keep the highest susceptibility against CRE, CRKP and XDRAB.

关 键 词：碳青霉烯 广泛耐药 革兰阴性菌 中国 

分 类 号：R978[医药卫生—药品]