2014至2015年全国血流感染细菌耐药监测报告  

Distribution and antimicrobial resistance profile of clinical bacterial isolates from blood culture in China, 2014-2015

作　　者：陈云波[1,2] 嵇金如 应超群 黄颖 沈继录[3,29] 丁卉[4] 黄金伟[4,30] 戴媛媛[5] 刘永云 张立平[7] 郭良[8] 张保华[9] 李艳红 茆海丰[11] 汪丽[12] 郑琳[12] 顾蓓青[13] 董海新[14] 宛传丹[15] 廖智香[16] 徐荣 虎淑妍 孙丽 张书存 马岚[21] 全博 王建中 杨正海[24] 朱文成 杜飞[26] 乔登嫣 夏修三 李兰娟[1,2] 肖永红 Chen Yunbo;Ji Jinru;Ying Chaoqun;Huang Ying;Shen Jilu;Ding Hui;Huang Jinwei;Dai Yuanyuan;Liu Yongyun;Zhang Liping;Guo Liang;Zhang Baohua;Li Yanhong;Mao Haifeng;Wang Li;Zheng Lin;Gu Beiqing;Dong Haixin;Wan Chuandan;Liao Zhixiang;Xu Rong;Hu Shuyan;Sun Li;Zhang Shucun;Ma Lan;Quan Bo;Wang Jianzhong;Yang Zhenghai;Zhu Wencheng;Du Fei;Qiao Dengyan;Xia Xiusan;Li Lanjuan;Xiao Yonghong(State Key Laboratory for Diagnosis and Treatment of Infectious Diseases/The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;Clinical Laboratory, Anyang District Hospital of Henan Province, Anyang 455000, China;Clinical Laboratory, the First People’s Hospital of Lianyungang, Lianyungang 222002, China;Clinical Laboratory, the Affiliated Hospital of Ningbo Medical School, Ningbo 315211, China;Clinical Laboratory, Haining People’s Hospital of Zhejiang Province, Haining 314400, China;Clinical Laboratory, Affiliated Hospital of Jining Medical University, Jining 272000, China;Changshu Medicine Examination Institute, Changshu 215500, China;Clinical Laboratory, Xinjiang Uygur Autonomous Region Youyi Hospital, 835000, China;Clinical Laboratory, Yichun People's Hospital of Jiangxi Province, Yichun 336000, China;Clinical Laboratory, Qingyang People’s Hospital of Gansu Province, Qingyang 745000, China;Clinical Laboratory, the Third Hospital of Hefei, Hefei 230022, China;Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China;Clinical Laboratory, Lu An People’s Hospital of Anhui Province, Luan 237016, China;Clinical Laboratory, Jiayuguan First People’s Hospital of Gansu Province, Jiayuguan 735100, China;Clinical Laboratory, the Second People’s Hospital of Jingzhou, Jingzhou 530031, China;Clinical Laboratory, Xinyu Xinsteel Center Hospital of Jiangxi Province, Xinyu 338001, China;Clinical Laboratory, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China;Clinical Laboratory, Luan Civily Hospital of Anhui Province, Luan 237000, China;Clinical La

机构地区：[1]浙江大学医学院附属第一医院传染病诊治国家重点实验室,杭州310003 [10]河南省安阳地区医院检验科,安阳455000 [11]连云港市第一人民医院检验科,222002 [12]宁波大学医学院附属医院检验科,315211 [13]浙江省海宁市人民医院检验科,314400 [14]济宁医学院附属医院检验科,272000 [15]常熟市医学检验所,215500 [16]新疆犁州友谊医院检验科,835000 [17]江西省宜春市人民医院检验科,336000 [18]甘肃省庆阳市人民医院检验科,745000 [19]合肥市第三人民医院检验科,230022 [2]感染性疾病诊治协同创新中心,杭州310003 [20]安徽省六安市人民医院检验科,237016 [21]甘肃省嘉峪关市第一人民医院检验科,735100 [22]荆州市第二人民医院检验科,530031 [23]江西省新余市新钢医院检验科338001 [24]皖南医学院弋矶山医院检验科,安徽芜湖241001 [25]安徽省六安世立医院检验科,237000 [26]合肥市滨湖医院检验科,230601 [27]甘肃省中医院检验科,兰州730699 [28]安徽省庐江县人民医院检验科,巢湖231500 [29]安徽医科大学附属第四医院检验科,合肥230032 [3]安徽医科大学附属第一医院检验科,合肥230022 [30]温州医科大学附属第六医院呼吸科,323000 [31]深圳市盐田区人民医院中西医结合心血管内科,518081 [4]丽水市中心医院检验科,323000 [5]安徽省立医院检验科,合肥230036 [6]滨州医学院附属医院检验科,山东滨州256603 [7]宁夏回族自治区人民医院检验科,银川750021 [8]福建省宁德市闽东医院检验科,福安355000 [9]黄山市人民医院检验科,245000

出　　处：《中华临床感染病杂志》2019年第1期24-37,共14页Chinese Journal of Clinical Infectious Diseases

基　　金：浙江省重点研发计划:重要感染性疾病治疗的新技术研究(2015C03032).

摘　　要：目的建立细菌耐药主动监测体系,了解我国血流感染的病原菌分布及其耐药性。方法收集全国血流感染细菌耐药监测联盟(Blood bacterial resistant investigation collaborative system,BRICS)成员单位2014年1月至2015年12月所有按操作规程分离自血液的病原菌,统一按美国临床实验室标准化协会推荐的琼脂稀释法或肉汤稀释法进行抗菌药物药敏试验。采用Whonet 5.6进行数据分析。结果共收集26家成员单位4 801株病原菌,其中革兰阳性菌为1 798株(37.5%),革兰阴性菌3 003株(62.5%)。最常见的前10位病原菌为大肠埃希菌1 621株(33.8%)、凝固酶阴性葡萄球菌913株(19.0%)、肺炎克雷伯菌572株(11.9%)、金黄色葡萄球菌487株(10.1%)、鲍曼不动杆菌190株(4.0%)、铜绿假单胞菌183株(3.8%)、链球菌属145(3.0%)、阴沟肠杆菌141株(2.9%)、屎肠球菌135株(2.8%)和粪肠球菌87株(1.8%)。耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(Methicillin-resistant coagulase-negative Staphylococcs,MRCNS)流行率分别为33.9%(165/487)和56.9%(520/913),未检测到对万古霉素耐药的葡萄球菌。屎肠球菌对万古霉素的耐药率为0.7%(1/135),未检测到耐万古霉素的粪肠球菌。产超广谱β-内酰胺酶(Extended-spectrum β-lactamases,ESBLs)大肠埃希菌的检出率为56.9%(923/1 621),产ESBLs肺炎克雷伯菌的检出率为30.1%(172/572),产ESBLs变形杆菌的检出率为29.2%(7/24);大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、沙门菌属和柠檬酸杆菌属耐碳青霉烯的检出率分别为1.2%(20/1 621)、7.2%(41/572)、4.3%(6/141)、1.5%(1/67)和2.9%(1/34)。鲍曼不动杆菌对多黏菌素和替加环素的耐药率分别为2.6%(5/190)和8.9%(17 /190);铜绿假单胞菌对多黏菌素和磷霉素的耐药率分别为1.1%(2/183)和0.6%(1/183)。结论我国血流感染病原菌以革兰阴性菌为主,大肠埃希菌为最常见的病原菌;MRSA的�Objective To analyze the distribution and antimicrobial resistance profile of clinical bacterial strains isolated from blood culture in China. Methods Clinical bacterial strains isolated from blood culture from participating hospitals of Blood Bacterial Resistance Investigation Collaborative System (BRICS) during January 2014 to December 2015 were collected. Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods as recommended by US Clinical and Laboratory Standards Institute(CLSI)2018. The data were analyzed with Whonet 5.6 software. Results During the study period, 4 801 clinical bacterial isolates were collected from 26 hospitals, of which 1 798 (37.5%) were Gram-positive bacteria and 3 003 (62.5%) were gram-negative bacteria. The top 10 isolates were Escherichia coli (33.8%), coagulase-negative Staphylococcus (19.0%), Klebsiella pneumoniae (11.9%), Staphylococcus aureus (10.1%), Acinetobacter baumannii (4.0%), Pseudomonas aeruginosa (3.8%), Streptococcus (3.0%), Enterobacter sulcus (2.9%), Enterococcus faecium (2.8%) and Enterococcus faecalis (1.8%). Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 33.9%(165/487) and 56.9%(520/913) of Staphylococcus aureus and coagulase-negative Staphylococcus respectively. No vancomycin-resistant Staphylococcus was detected. The resistance rate of Enterococcus faecium to vancomycin was 0.7%(1/135), and no vancomycin-resistant Enterococcus faecaliss was detected. The positive rates of extended-spectrum β-lactamases(ESBLs)-producing Escherichia coli, Klebsiella pneumoniae and Proteus were 56.9%(923/1 621), 30.1%(172/572) and 29.2%(7/24), respectively. The positive rates of carbapenem-resistant Escherichia coli, Klebsiella pneumoniae, Enterobacter, Salmonella and Citrobacter were 1.2%(20/1 621), 7.2%(41/572), 4.3%(6/141), 1.5%(1/67)and 2.9%(1/34), respectively. The resistance rates of Acinetobacter baumannii to polymyxin and tegacycline were 2.6%(5/190)and 8

关 键 词：革兰氏阴性菌 革兰氏阳性菌 抗药性 细菌 血流感染 耐药监测 微生物敏感性试验 

分 类 号：R446[医药卫生—诊断学]