2018年CHINET中国细菌耐药性监测  

CHINET surveillance of bacterial resistance in China: 2018 report

作　　者：胡付品 郭燕 朱德妹 汪复 蒋晓飞[2] 徐英春[3] 张小江[3] 张朝霞[4] 季萍[4] 谢轶 康梅 王传清[6] 王爱敏[6] 徐元宏 沈继录 孙自镛[8] 陈中举 倪语星[9] 孙景勇[9] 褚云卓[10] 田素飞[10] 胡志东 李金 俞云松[12] 林洁[12] 单斌 杜艳 郭素芳[14] 魏莲花[15] 邹凤梅[15] 张泓[16] 王春[16] 胡云建[17] 艾效曼[17] 卓超 苏丹虹 汪瑞忠[19] 房华[19] 俞碧霞 赵勇 龚萍 郭大文 赵金英 刘文恩 李艳明 金炎[24] 邵春红[24] 温开镇 张贻荣 徐雪松[26] 鄢超[26] 喻华[27] 黄湘宁[27] 王山梅[28] 楚亚菲 张利侠[29] 马娟[29] 周树平[30] 周艳[30] 朱镭[31] 孟晋华[31] 董芳[32] 郑红艳 沈瀚[33] 周万青[33] 贾伟[34] 李刚[34] 吴劲松[35] 卢月梅[35] 李继红[36] 刘江山[37] 廖龙凤[38] 顾洪芹[39] 姜琳[40] 贺雯[41] 薛顺虹[42] 冯佼[43] 窦睿[44] 岳春雷[45] HU Fupin;GUO Yan;ZHU Demei;WANG Fu;JIANG Xiaofei;XU Yingchun;ZHANG Xiaojiang;ZHANG Zhaoxia;JI Ping;XIE Yi;KANG Mei;WANG Chuanqing;WANG Aimin;XU Yuanhong;SHEN Jilu;SUN Ziyong;CHEN Zhongju;NI Yuxing;SUN Jingyong;CHU Yunzhuo;TIAN Sufei;HU Zhidong;LI Jin;YU Yunsong;LIN Jie;SHAN Bin;DU Yan;GUO Sufang;WEI Lianhua;ZOU Fengmei;ZHANG Hong;WANG Chun;HU Yunjian;AI Xiaoman;ZHUO Chao;SU Danhong;WANG Ruizhong;FANG Hua;YU Bixia;ZHAO Yong;GONG Ping;GUODawen;ZHAO Jinying;LIU Wen'en;LI Yanming;JIN Yan;SHAO Chunhong;WEN Kaizhen;ZHANG Yirong;XUXuesong;YAN Chao;YU Hua;HUANG Xiangning;WANG Shanmei;CHU Yafei;ZHANG Lixia;MA Juan;ZHOU Shuping;ZHOU Yan;ZHU Lei;MENG Jinhua;DONG Fang;ZHENG Hongyan;SHEN Han;ZHOU Wanqing;JIA Wei;LI Gang;WU Jinsong;LU Yuemei;LI Jihong;LIU Jiangshan;LIAO Longfeng;GU Hongqin;JIANG Lin;HE Wen;XUE Shunhong;FENG Jiao;DOU Rui;YUE Chunlei(Institute of Antibiotics,Huashan Hospital,Fudan University,Shanghai 200040,China;不详)

机构地区：[1]复旦大学附属华山医院抗生素研究所,上海200040 [2]复旦大学附属华山医院检验科,上海200040 [3]北京协和医院 [4]新疆医科大学第一附属医院 [5]四川大学华西医院 [6]复旦大学附属儿科医院 [7]安徽医科大学第一附属医院 [8]华中科技大学同济医学院附属同济医院 [9]上海交通大学医学院附属瑞金医院 [10]中国医科大学附属第一医院 [11]天津医科大学总医院 [12]浙江大学医学院附属邵逸夫医院 [13]昆明医科大学第一附属医院 [14]内蒙古医科大学附属医院 [15]甘肃省人民医院 [16]上海交通大学附属儿童医院,上海市儿童医院 [17]北京医院 [18]广州医科大学附属第一医院 [19]上海市浦东新区人民医院 [20]浙江省宁波市镇海龙赛医院 [21]湖北省秭归县人民医院 [22]哈尔滨医科大学第一附属医院 [23]中南大学湘雅医院 [24]山东省立医院 [25]福建省晋江医院 [26]吉林大学中日联谊医院 [27]四川省人民医院 [28]河南省人民医院 [29]陕西省人民医院 [30]江西省儿童医院 [31]山西省儿童医院 [32]首都医科大学附属北京儿童医院 [33]南京大学医学院附属鼓楼医院 [34]宁夏医科大学总医院 [35]广东省深圳市人民医院 [36]河北医科大学第二医院 [37]甘肃省金昌市中西医结合医院 [38]江西省赣县区人民医院 [39]山东省广饶县人民医院 [40]河南省辉县市人民医院 [41]辽宁省营口经济技术开发区中心医院 [42]青海省互助土族自治县人民医院 [43]四川省邻水县人民医院 [44]安徽省利辛县人民医院 [45]吉林省九台区人民医院

出　　处：《中国感染与化疗杂志》2020年第1期1-10,共10页Chinese Journal of Infection and Chemotherapy

基　　金：辉瑞IIR基金(WI207259)支持。

摘　　要：目的监测国内各省市主要医疗机构临床分离菌株对抗菌药物的敏感性。方法对国内主要地区44所医院临床分离菌按CHINET统一监测方案进行抗菌药物敏感性试验。按2018年CLSI文件标准判断结果。结果收集2018年1-12月上述医院临床分离菌共244843株,其中革兰阳性菌占28.2%,革兰阴性菌占71.8%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)的平均检出率分别为34.0%和78.9%。MRSA和MRCNS对绝大多数测试药的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。MRSA中有92.2%的菌株对甲氧苄啶-磺胺甲唑敏感;MRCNS中有88.0%的菌株对利福平敏感;未发现万古霉素耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株。肺炎链球菌非脑膜炎株儿童株中PSSP(89.4%)和PRSP(1.7%)所占比例较2016年有所下降。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于17%(除克雷伯菌属外)。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别从2005年的3.0%和2.9%上升到了2018年的25.0%和26.3%。与此同时,肺炎克雷伯菌每年的占比亦呈逐步上升趋势。不动杆菌属(鲍曼不动杆菌占92.5%)对亚胺培南和美罗培南的耐药率分别为73.2%和73.9%;铜绿假单胞菌对上述两药的耐药率分别为30.7%和25.8%;耐药率均呈上升趋势。结论临床分离菌对常见抗菌药物的耐药率仍呈增长趋势,尤其是碳青霉烯类耐药肺炎克雷伯菌,应加强医院感染防控措施和抗菌药物临床应用管理措施,在继续做好细菌耐药监测工作的同时加强实验室与临床的沟通,以发挥细菌耐药监测工作的最大价值。Objective To investigate the susceptibility and resistance profile of clinical isolates from hospitals across China.Methods A total of 44 hospitals were involved in this program.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2018 breakpoints.Results A total of 244,843 clinical isolates were collected from Junuary to December 2018,of which gram negative organisms and gram positive cocci accounted for 71.8%and 28.2%respectively.Methicillin-resistant strains in S.aureus(MRSA)and coagulase negative Staphylococcus(MRCNS)accounted for an average of 34.0%and 78.9%,respectively.The resistance rates of MR strains to most of other antimicrobial agents were much higher than those of MS strains.However,92.2% of MRSA strains were still susecptilbe to trimethoprim-sulfamethoxazole,while 88.0%of MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin.In Enterococcus spp.,the resistance rates of E.faecalis strains to most tested drugs were much lower than those of E.faecium.A few strains of both species were resistant to vancomycin.As for non-meningitis S.pneumoniae strains,unlike the isolates from adults,the prevalence of PSSP(89.4%)or PRSP(1.7%)strains isolated from children were lower than those isolated in 2016.The strains of Enterobacteriaceae were still highly susceptible to carbapenems.Overall,less than 17%of these strains were resistant to carbapenems(except Klebsiella spp.).A remarkable increase of resistance to imipenem and meropenem was seen in K.pneumoniae from 3.0%to 25.0%and from 2.9%to 26.3%during the period from 2005 to 2018.The proportion of K.pneumoniae was also increasing stably among gram-negative bacilli.About 73.2%and 73.9%of Acinetobacter spp.(A.baumannii accounts for 92.5%)strains were resistant to imipenem and meropenem,respectively.About 30.7%and 25.8%of the P.aeruginosa isolates were resistant to imipenem and meropenem respectively,h

关 键 词：细菌耐药监测 药物敏感性试验 万古霉素耐药肠球菌 甲氧西林耐药葡萄球菌 青霉素耐药肺炎链球菌 碳青霉烯类耐药革兰阴性菌 

分 类 号：R378[医药卫生—病原生物学]