中国细菌耐药监测研究2019-2020革兰氏阳性菌监测报告  

Antimicrobial susceptibility of Gram-positive organisms:Results from China antimicrobial resistance surveillance trial(CARST) program,2019-2020

作　　者：李耘[1] 郑波[1] 吕媛[1] 薛峰[1] 张秀珍[2] 胡云建[2] 金玉芬[3] 胡志东[4] 赵建宏[5] 潘世扬[6] 李华茵[7] 俞云松[8] 李艳[9] 刘文恩[10] 刘德华[11] 费樱 刘智勇 徐修礼 裴凤艳[15] 孟灵[16] 季萍[17] 汤进[18] 符惠群[19] 朱镭[20] 王珊[1] 张佳[1] 王青 刘姚姚 LI Yun;ZHENG Bo;Lü Yuan;XUE Feng;ZHANG Xiu-zhen;HU Yun-jian;JIN Yu-fen;HU Zhi-dong;ZHAO Jian-hong;PAN Shi-yang;LI Hua-yin;YU Yun-song;LI Yan;LIU Wen-en;LIU De-hua;FEI Ying;LIU Zhi-yong;XU Xiu-li;PEI Feng-yan;MENG Ling;JI Ping;TANG Jin;FU Hui-qun;ZHU Lei;WANG Shan;ZHANG Jia;WANG Qing;LIU Yao-yao(Institute of Clinical Pharmacology,Peking University First Hospital,Beijing 100034,China;Clinical Laboratory,Beijing Hospital,Beijing 100730,China;Clinical Laboratory,Jilin University Second Hospital,Changchun 130041,Jilin Province,China;Clinical Laboratory,Tianjin Medical University General Hospital,Tianjin 300052,China;Clinical Laboratory,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China;Clinical Laboratory,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,Jiangsu Province,China;Respiratory Department,Zhongshan Hospital Fudan University,Shanghai 200023,China;Infectious Disease Department,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310003,Zhejiang Province,China;Clinical Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei Province,China;Clinical Laboratory,Xiangya Hospital Central-south UniversityChangsha 410008,Hunan Province,China;Clinical Laboratorym Kunming First People s Hospital,Kunming 650011,Yunnan Province,China;Clinical Laboratory,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,Guizhou Province,China;Clinical Laboratory,The First Hospital Affiliated to Army Medical Universiry,Chongqing 400038,China;Clinical Laboratory,Air Force Military Medical University Xijing Hospital,Xi'an 710032^Shaanxi Province,China;Clinical Laboratory,Jinan Central Hospital Affiliated to Shandong University,Jinan 250013,Shandong Province,China;Clinical Laboratory,Lanzhou University Second Hospital,Lanzhou 730030,Gansu Province,China;Clinical Laboratory,The First Teaching Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China;Clinical Laboratory,Hanzhong Center Hospital,Hanzh

机构地区：[1]北京大学第一医院临床药理研究所,北京100034 [2]北京医院检验科,北京100730 [3]吉林大学第二医院检验科,吉林长春130041 [4]天津医科大学总医院检验科,天津300052 [5]河北医科大学第二医院检验科,河北石家庄050000 [6]南京医科大学第一附属医院检验科,江苏南京210029 [7]复旦大学中山医院呼吸科,上海200023 [8]浙江大学邵逸夫医院感染科,浙江杭州310003 [9]武汉大学人民医院检验科,湖北武汉430060 [10]中南大学湘雅医院检验科,湖南长沙410008 [11]昆明市第一人民医院检验科,云南昆明650011 [12]贵州医科大学附属医院检验科,贵州贵阳550001 [13]陆军军医大学第一附属医院检验科,重庆400038 [14]空军军医大学西京医院检验科,陕西西安710032 [15]山东大学附属济南市中心医院检验科,山东济南250013 [16]兰州大学第二医院检验科,甘肃兰州730030 [17]新疆医科大学第一医院检验科,新疆维吾尔自治区乌鲁木齐830054 [18]汉中市中心医院检验科,陕西汉中723000 [19]海南省人民医院检验科,海南海口570311 [20]山西省儿童医院检验科,山西太原300012

出　　处：《中国临床药理学杂志》2022年第4期369-384,共16页The Chinese Journal of Clinical Pharmacology

摘　　要：目的监测我国主要城市三级甲等医院住院患者分离革兰氏阳性菌耐药状况,掌握耐药流行趋势,为抗生素合理使用提供科学数据。方法定点收集来自全国19家医院临床分离细菌,由中心实验室统一用平皿/肉汤二倍稀释法测定抗菌药物最低抑菌浓度(MIC)值。结果对2019年7月至2020年6月间来自全国19座城市19家医院的2 377株临床分离致病菌进行了MIC测定。结果显示,甲氧西林耐药金黄色葡萄球菌(MRSA)和甲氧西林耐药表皮葡萄球菌(MRSE)检出率分别为34.8%和82.1%。未发现万古霉素不敏感葡萄球菌,金黄色葡萄球菌对利奈唑胺、替考拉宁100%敏感。粪肠球菌、屎肠球菌对氨苄西林的耐药率分别为4.5%和91.4%。万古霉素耐药肠球菌(VRE)检出率1.76%,利奈唑胺不敏感率粪肠球菌比例为19.8%,较前次监测上升明显。青霉素不敏感肺炎链球菌(PNSSP)检出率按非脑膜炎、非肠道系统给药折点计算为28.5%,按口服青霉素V折点计算为78.7%,连续两届监测呈上升趋势。金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、屎肠球菌不同病房、不同年龄以及不同标本来源菌株耐药率比较差异均无统计学意义,肺炎链球菌不同年龄组间耐药率差异均无统计学意义。结论 VRE检出率稳定在低水平;MRSA检出率有所下降;肺炎链球菌对青霉素耐药率有所升高,值得注意。Objective resistance in nationwide’s tertiary hospitals and understand the trend of antimicrobial resistance. Method All the clinical isolates were collected from 19 hospitals and the minimal inhibitory concentrations( MICs) were tested using agar/broth dilution method recommended by Clinical and Laboratory Standards Institute( CLSI) in central laboratory. The susceptibilities of isolates to antimicrobial agents were determined by using CLSI or European Committee on Antimicrobial Susceptibility Testing( EUCAST) 2021 guideline. Results A total of 2 377 pathogenic gram-positive coccus from 19 tertiary hospitals in 19 cities nationwide over the period from July 2019 to June 2020 were studied. Based on the MIC results,the prevalence of Methicillin Resistant Stapylococcus aureus(MRSA) and Methicillin Resistant Stapylococcus epidermidis( MRSE)were 34. 8% and 82. 1% respectively. No vancomycin insensitive staphylococcus was detected. S. aureus were 100% susceptible to linezolid and teicoplanin. Antibiotic resistance rate of Enterococcus faecalis and Enterococcus faecium to ampicillin were 4. 5% and 91. 4%. The detection rate of Vancomycin Resistant Enterococcus( VRE) was 1. 8%. Nonsusceptibility rate of Enterococcus faecalis to linezolid was19. 8%,significantly higher than last time. The prevalence of Penicillin Non-Susceptible Streptococcus pneumoniae( PNSSP) was 28. 5% based on non-meningitis and parenteral administration criterion;while for cases of oral penicillin,the rate was 78. 7%,showing rising trend for two consecutive surveillance. There were no significant differences of resistance rates of Stapylococcus aureus,Stapylococcus epidermidis,Enterococcus faecalis,Enterococcus faecium and Streptococcus pneumoniae among various groups such as different department,age,or specimen source.Conclusion VRE detection ratio stablized at a relatively low level,while MRSA detection ratio continuously decrease.The resistance rates of Streptococcus pneumoniae to penicillin increased,which should be paid more attention.

关 键 词：细菌耐药监测 革兰氏阳性菌 最低抑菌浓度 敏感率 耐药率 最低抑菌浓度分布 

分 类 号：R978.1[医药卫生—药品]