2011年、2013年和2016年医院内获得性血流感染常见病原菌分布及其耐药性分析  

Microbiological profiles of pathogens causing nosocomial bacteremia in 2011, 2013 and 2016

作　　者：王晓娟[1] 赵春江[1] 李荷楠[1] 陈宏斌[1] 靳龙阳 王占伟[1] 廖康[2] 曾吉[3] 徐修礼 金炎[5] 苏丹虹[6] 刘文恩[7] 胡志东[8] 曹彬[9,10] 褚云卓[11] 张嵘[12] 罗燕萍[13] 胡必杰[14] 王辉[1] Xiaojuan Wang;Chunjiang Zhao;Henan Li;Hongbin Chen;Longyang Jin;Zhanwei Wang;Kang Liao;Ji Zeng;Xiuli Xu;Yan Jin;Danhong Su;Wenen Liu;Zhidong Hu;Bin Cao;Yunzhuo Chu;Rong Zhang;Yanping Luo;Bijie Hu;Hui Wang(Department of Clinical Laboratory,Peking University People＇s Hospital,Beijing 100044,China;Department of Clinical Laboratory,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong,China;Department of Clinical Laboratory,Puai Hospital of Tongji Medical College of Huazhong University of Science ＆ Technology,Wuhan 430030,Hubei,China;Department of Clinical Laboratory,Xijing Hospital,Air Force Military Medical University,Xi＇an 710032,Shaanxi,China;Department of Clinical Laboratory,Shandong Provincial Hospital,Jinan 250012,Shandong,China;Guangzhou Institute of Respiratory Disease,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,Guangdong,China;Department of Clinical Laboratory,Xiangya Hospital of Central South University,Changsha 410013,Hunan,China;Department of Clinical Laboratory,Tianjin Medical University General Hospital,Tianjin 300070,China;Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital and National Clinical Research Center for Respiratory Diseases,Beijing 100029,China;Department of Infectious Diseases and Clinical Microbiology,Beijing Chao Yang Hospital of Capital Medical University,Beijing 100020,China;Department of Clinical Laboratory,The First Affiliated Hospital of China Medical University,Shenyang 110122,Liaoning,China;Department of Clinical Laboratory,The Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,Zhejiang,China;Department of Clinical Microbiology,Chinese PLA General Hospital,Beijing 100039,China;Department of Clinical Microbiology,Zhongshan Hospital of Fudan University,Shanghai 200032,China)

机构地区：[1]北京大学人民医院检验科,北京100044 [2]中山大学附属第一医院检验科,广东广州510080 [3]华中科技大学同济医学院附属普爱医院检验科,湖北武汉430030 [4]空军军医大学西京医院检验科,陕西西安710032 [5]山东大学附属省立医院检验科,山东济南250012 [6]广州呼吸疾病研究所,广东广州510120 [7]中南大学湘雅医院检验科,湖南长沙410013 [8]天津医科大学总医院检验科,天津300070 [9]中日友好医院呼吸与危重症医学科,北京100029 [10]首都医科大学附属北京朝阳医院检验科感染与临床微生物科,北京100020 [11]中国医科大学附属第一医院检验科,辽宁沈阳110122 [12]浙江大学医学院附属第二医院检验科,浙江杭州310009 [13]中国人民解放军总医院临床微生物科,北京100039 [14]复旦大学附属中山医院临床微生物科,上海200032

出　　处：《生物工程学报》2018年第8期1205-1217,共13页Chinese Journal of Biotechnology

基　　金：国家自然科学基金(Nos.81625014;81661138006)资助~~

摘　　要：动态监测2011年、2013年和2016年我国不同地区医院内获得性血流感染病原菌分布及耐药进展趋势。从全国10个城市回顾性收集血流感染病原菌非重复性株,采用琼脂稀释法或微量肉汤稀释法进行药物敏感性试验,采用Whonet 5.6软件对药敏试验结果进行分析。收集的2 248株血流感染病原菌中革兰阴性杆菌为1 657株(占73.7%),革兰阳性球菌为591株(占26.3%)。分离率排名前五的病原菌依次为大肠埃希菌(32.6%,733株/2 248株)、肺炎克雷伯菌(14.5%,327株/2 248株)、金黄色葡萄球菌(10.0%,225株/2 248株)、鲍曼不动杆菌(8.7%,196株/2 248株)和铜绿假单胞菌(6.2%,140株/2 248株)。血流感染分离的革兰阴性杆菌对抗菌药物体外敏感率较高的抗菌药物依次为粘菌素(96.5%,1 525株/1 581株,不包括天然耐药菌株)、替加环素(95.6%,1 375株/1 438株,不包括天然耐药菌株)、头孢他啶/克拉维酸(89.2%,1 112株/1 246株)、阿米卡星(86.4%,1 382株/1 599株)和美罗培南(85.7%,1 376株/1 605株);革兰阳性球菌对抗菌药物体外敏感率较高的抗菌药物依次为替加环素、替考拉宁和达托霉素(敏感率均为100.0%)、万古霉素和利奈唑胺(敏感率均为99.7%)。2011年、2013年和2016年产超广谱β-内酰胺酶肠杆菌科细菌分离率分别为50.6%(206株/407株)、49.8%(136株/273株)和38.9%(167株/429株);碳青霉烯不敏感肠杆菌科细菌分离率分别为2.2%(9株/408株)、4.0%(16株/402株)和3.9%(17株/439株);多重耐药鲍曼不动杆菌分离率分别为76.4%(55株/72株)、82.7%(43株/52株)和87.5%(63株/72株),多重耐药铜绿假单胞菌分离率分别为9.8%(5株/51株)、20.0%(7株/35株)和13.0%(7株/54株);甲氧西林耐药金黄色葡萄球菌的分离率分别为51.9%(41株/79株)、29.7%(19株/64株)和31.7%(26株/82株)。屎肠球菌和粪肠球菌中高水平庆大霉素耐药株分离率分别为43.2%(48株/111株)和40.9%(27株/66株)。碳青霉烯不敏感肠杆菌科细菌中肺To dynamically investigate the distribution and antimicrobial resistance profiles of bacteremia pathogens isolated from different regions in China in 2011, 2013 and 2016. Non-repetitive isolates from nosocomial bloodstream infections were retrospectively collected and detected for antimicrobial susceptibility tests（AST） by agar dilution or microbroth dilution methods. Whonet 5.6 was used to analyze the AST data. Among 2 248 isolates, 1 657（73.7%） were Gram-negative bacilli and 591（26.3%） were Gram-positive cocci. The top five bacteremia pathogens were as follows, Escherichia coli（32.6%, 733/2 248）, Klebsiella pneumoniae（14.5%, 327/2 248）, Staphylococcus aureus（10.0%, 225/2 248）, Acinetobacter baumannii（8.7%, 196/2 248） and Pseudomonas aeruginosa（6.2%, 140/2 248）. Colistin（96.5%, 1 525/1 581, excluding innate resistant organisms）, tigecycline（95.6%, 1 375/1 438, excluding innate resistant organisms）, ceftazidine/clavulanate acid（89.2%, 1 112/1 246）, amikacin（86.4%, 1 382/1 599） and meropenem（85.7%, 1 376/1 605） showed relatively high susceptibility against Gram-negative bacilli. While tigecycline, teicoplanin and daptomycin（the susceptibility rates were 100.0%）, vancomycin and linezolid（the susceptibility rates were 99.7%） demonstrated high susceptibility against Gram-positive cocci. The prevalence of extended-spectrum β-lactamases（ESBLs）-producing Enterobacteriaceae were 50.6%（206/407）, 49.8%（136/273） and 38.9%（167/429） in 2011, 2013 and 2016 respectively; carbapenem-non-susceptible Enterobacteriaceae were 2.2%（9/408）, 4.0%（16/402） and 3.9%（17/439） in 2011, 2013 and 2016 respectively; The prevalence of multidrug-resistant A. baumannii（MDRA） was 76.4%（55/72） in 2011, 82.7%（43/52） in 2013 and 87.5%（63/72） in 2016, respectively. The prevalence of multidrug-resistant P. aeruginosa（MDRP） was 9.8%（5/51） in 2011, 20.0%（7/35） in 2013 and 13.0%（7/54） in 2016, respectively. The prevalence of methicillin-

关 键 词：血流感染 菌血症 病原谱 抗菌药物耐药性 

分 类 号：R446.5[医药卫生—诊断学]