2016至2017年全国血流感染细菌耐药监测(BRICS)报告  

BRICS report of 2016-2017:the distribution and antimicrobial resistance profile of clinical isolates from blood culture in China

作　　者：陈云波[1,2] 嵇金如 应超群 王培培 杨青 孔海深[1,2] 刘永云 黄颖[4] 戴媛媛 张立平[6] 丁卉[7] 郭良[8] 张保华[9] 朱丽莎[10] 茆海丰 廖智香[12] 李艳红[13] 王璐[14] 虎淑妍 杨正海[16] 顾蓓青 董海新 杜飞[19] 郑琳[20] 全博[21] 朱文成 王建中[23] 马岚[24] 徐荣 孙丽 李爱云 曹俊敏 梁金花[29] 徐红云[30] 梁坤鹏[31] 乔登嫣 戚晓燕[33] 夏修三[34] 李兰娟[1,2] 肖永红 Chen Yunbo;Ji Jinru;Ying Chaoqun;Wang Peipei;Yang Qing;Kong Haishen;Liu Yongyun;Huang Ying;Dai Yuanyuan;Zhang Liping;Ding Hui;Guo Liang;Zhang Baohua;Zhu Lisha;Mao Haifeng;Liao Zhixiang;Li Yanhong;Wang Lu;Hu Shuyan;Yang Zhenghai;Gu Beiqing;Dong Haixin;Du Fei;Zheng Lin;Quan Bo;Zhu Wencheng;Wang Jianzhong;Ma Lan;Xu Rong;Sun Li;Li Aiyun;Cao Junmin;Liang Jinhua;Xu Hongyun;Liang Kunpeng;Qiao Dengyan;Qi Xiaoyan;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;Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Clinical Laboratory,Affiliated Hospital of Binzhou Medical College,Binzhou 256603,Shandong Province,China;Clinical Laboratory,First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Clinical Laboratory,Anhui Provincial Hospital,Hefei 230036,China;Clinical Laboratory,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750021,China;Clinical Laboratory,Lishui City Central Hospital,Lishui 323000,Zhejiang Province,China;Clinical Laboratory,Mindong Hospital of Ningde City,Fu’an 355000,Fujian Province,China;Clinical Laboratory,People’s Hospital of Huangshan City,Huangshan 245000,Anhui Province,China;Clinical Laboratory,the First People’s Hospital of Jingzhou,Jingzhou 434000,Hubei Province,China;Clinical Laboratory,the First People’s Hospital of Lianyungang,Lianyungang 222002,Jiangsu Province,China;Clinical Laboratory,Xinjiang Uygur Autonomous Region Youyi Hospital,Yili 835000,China;Clinical Laboratory,Anyang District Hospital,Anyang 455000,Henan Province,China;Clinical Laboratory,Lu’an People’s Hospital,Lu’an 237005,Anhui Province,China;Clinical Laboratory,People’s Hospital of Qingyang,Qingyang 745000,Gansu Province,China;Clinical Laboratory,Yijishan Hospital of Wannan Medical College,Wuhu 241001,Anhui Province,

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 [2]浙江大学医学院附属第一医院感染性疾病诊治协同创新中心,杭州310003 [3]山东省滨州医学院附属医院检验科,256603 [4]安徽医科大学附属第一医院检验科,合肥230022 [5]安徽省立医院检验科,合肥230036 [6]宁夏回族自治区人民医院检验科,银川750021 [7]丽水市中心医院检验科,323000 [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 [10]湖北省荆州市第一人民医院检验科,434000 [11]江苏省连云港市第一人民医院检验科,222002 [12]新疆犁州友谊医院检验科,伊犁835000 [13]河南省安阳地区医院检验科,455000 [14]安徽省六安市第一人民医院,237005 [15]甘肃省庆阳市人民医院检验科,745000 [16]安徽省皖南医学院弋矶山医院检验科,芜湖241001 [17]浙江省海宁市人民医院检验科,314400 [18]济宁医学院附属医院检验科,272000 [19]合肥市湖滨医院检验科,230601 [20]宁波大学医学院附属医院检验科,315211 [21]湖北省荆州市第二人民医院检验科,530031 [22]安徽省六安世立医院检验科,237000 [23]江西省新余市新钢医院检验科,338001 [24]甘肃省嘉峪关市第一人民医院检验科,735100 [25]江西省宜春市人民医院检验科,336000 [26]合肥市第三人民医院检验科,230022 [27]浙江大学医学院附属妇产科医院检验科,杭州310006 [28]浙江省中医院检验科,杭州310006 [29]黑龙江省牡丹江医学院附属红旗医院检验科,157011 [30]云南省第二人民医院检验科,昆明650021 [31]安徽省蚌埠医学院第二附属医院检验科,233040 [32]甘肃省中医院检验科,兰州730699 [33]安徽省六安市儿童医院检验科,237006 [34]安徽庐江县人民医院检验科,巢湖231500

出　　处：《中华临床感染病杂志》2020年第1期42-54,共13页Chinese Journal of Clinical Infectious Diseases

基　　金：国家科技重大专项(2018ZX10733402-004);国家自然科学基金(81711530049);浙江省重点研发计划(2015C03032)。

摘　　要：目的通过研究血液感染的病原菌分布及对其耐药性监测,准确掌握我国细菌耐药状况。方法收集全国血流感染细菌耐药监测联盟(BRICS)成员单位2016年1月至2017年12月所有按操作规程分离自血培养的感染病原菌,按美国临床和实验室标准化研究所(CLSI)推荐的琼脂稀释法或肉汤稀释法进行抗菌药物药敏性测定。采用WHONET 5.6进行统计分析。结果2016年1月至2017年12月共收集33家成员单位8154株病原菌,其中革兰阳性菌为2325株(28.5%),革兰阴性菌5829株(71.5%)。最常见的前10位病原菌为大肠埃希菌2831株(34.7%)、肺炎克雷伯菌1289株(15.8%)、金黄色葡萄球菌922株(11.3%)、凝固酶阴性葡萄球菌605株(7.4%)、鲍曼不动杆菌372株(4.6%)、铜绿假单胞菌315株(3.9%)、屎肠球菌312株(3.8%)、链球菌属237株(2.9%)、阴沟肠杆菌220株(2.7%)和粪肠球菌205株(2.5%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为34.2%(315/922)和77.7%(470/605),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0.6%(2/312),未检测到耐万古霉素的粪肠球菌。产超广谱β-内酰胺酶(ESBLs)大肠埃希菌、肺炎克雷伯菌、变形杆菌属分别为55.7%(1576/2831)、29.9%(386/1289)、38.5%(15/39);耐碳青霉烯类大肠埃希菌、肺炎克雷伯菌分别为1.2%(33/2831)、17.5%(226/1289)。鲍曼不动杆菌对多黏菌素B和替加环素的耐药率分别为14.8%(55/372)和5.9%(22/372);铜绿假单胞菌对多黏菌素B和碳青霉烯类的耐药率分别为1.3%(4/315)和18.7%(59/315)。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的检出率较国内同期其他监测低;耐碳青霉烯大肠埃希菌处于较低水平,耐碳青霉烯肺炎克雷伯菌呈上升趋势。Objective To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System(BRICS)were collected during January 2016 to December 2017.Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute(CLSI)2019.WHONET 5.6 was used to analyze data.Results During the study period,8154 bacterial strains were collected from 33 hospitals,of which 2325(28.5%)were Gram-positive bacteria and 5829(71.5%)were Gram-negative bacteria.The top 10 bacterial species were Escherichia coli(34.7%),Klebsiella pneumoniae(15.8%),Staphylococcus aureus(11.3%),coagulase-negative Staphylococci(7.4%),Acinetobacter baumannii(4.6%),Pseudomonas aeruginosa(3.9%),Enterococcus faecium(3.8%),Streptococci(2.9%),Enterobacter cloacae(2.7%)and Enterococcus faecalis(2.5%).Methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant coagulase-negative Staphylococcus(MRCNS)accounted for 34.2%(315/922)and 77.7%(470/605),respectively.No vancomycin-resistant Staphylococcus was detected.The resistance rate of Enterococcus faecium to vancomycin was 0.6%(2/312),and no vancomycin-resistant Enterococcus faecium was detected.The ESBLs-producing rates in Escherichia coli,Klebsiella pneumoniae and Proteus were 55.7%(1576/2831),29.9%(386/1289)and 38.5%(15/39),respectively.The incidences of carbapenem-resistance in Escherichia coli,Klebsiella pneumoniae were 1.2%(33/2831),17.5%(226/1289),respectively.The resistance rates of Acinetobacter baumannii to polymyxin and tigecycline were 14.8%(55/372)and 5.9%(22/372)respectively,and those of Pseudomonas aeruginosa to polymyxin and carbapenem were 1.3%(4/315)and 18.7%(59/315),respectively.Conclusion The surveillance results from 2016 to 2017 showed that the main pathogens of blood stream infection in China were gram-

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

分 类 号：R446[医药卫生—诊断学]