中国细菌耐药监测(CARST)研究2019-2020革兰氏阴性菌监测报告  

Antimicrobial susceptibility of Gram-negative 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 Provincey China;Clinical Laboratory,Xiangya Hospital Central-south University,Changsha 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,Ha

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5期432-452,共21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的革兰氏阴性菌的细菌耐药状况,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月来自全国19座城市19家医院的4795株临床分离致病菌进行了MIC测定。结果显示,大肠埃希菌和肺炎克雷伯菌中超广谱β内酰胺酶(ESBLs)表型检出率分别为52.8%和23.6%,均持续下降,碳青霉烯类耐药肺炎克雷伯菌比例与前次监测持平。对肠杆菌目细菌抗菌作用较好的药物包括碳青霉烯类、阿米卡星、拉氧头孢、β内酰胺类合剂、磷霉素氨丁三醇和西他沙星等。非发酵革兰阴性菌中铜绿假单胞菌和鲍曼不动杆菌对亚安培南的耐药率分别为27.1%和70.7%,多重耐药菌(MDR)检出率分别为39.7%和74.9%,泛耐药菌(XDR)检出率分别为11.8%和69.0%。不同病房、不同年龄以及不同标本来源菌株耐药率比较提示,重症监护病房分离肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中MDR占比更高,儿童患者分离肺炎克雷伯菌中ESBLs检出率高于成人和老年人,我国儿童中细菌耐药问题不容忽视。结论ESBLs检出率有所下降;碳青霉烯类耐药肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌比例稳定;鲍曼不动杆菌对米诺环素耐药率有所升高,值得注意。Objective To investigate the gram-negative bacteria resistance in nationwide’s tietiary hospitals and understand the trend of antimicrobial resistance.Methods 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 4 795pathogenic isolates from 19 tertiary hospitals in 19 cities nationwide over the period from July 2019 to June 2020 were studied.Based on the MIC results,Escherichia coli and Klebsiella pneumoniae showed Extended Spectrumβ-lactamase (ESBLs) phenotype rates of 52.8%and23.6%,respectively,both keep going down.The ratios of carbapenems resistance Klebsiella pneumoniae were same as last time.Carbapenems,amikacin,moxalactam,β-lactam combination agents,fosfomycin trometamol and sitafloxacin displayed desirable antibacterial activity against Enterbacterales.For non-fermenting Gram-negative isolates,resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannnii to imipennnem were 27.1%and 70.7%and multidrug-resistant (MDR) detection rates were 39.7%and 74.9%,Extensively drug-resistant (MDR) were11.8%and 69.0%,respectively.Comparison of drug resistance rates from different wards,ages and specimen sources indicated that the proportion of MDR in KLEbsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa isolated from ICU were higher than non-ICU.Klebsiella pneumoniae isolated from children were more ESBLs positive than those from adults and the old people,so bacterial resistance in children is an important problem in China.Conclusion ESBLs detection ratios continuously decrease.Carbapenem resistance Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii rates were same as last time.The resistance

关 键 词：细菌耐药监测 革兰氏阴性菌 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]