中国细菌耐药监测研究(CARST)2021—2022年革兰氏阳性菌监测报告  

Antimicrobial susceptibility of Gram-positive organisms:Resultss from China antimicrobial resistance surveillance trial(CARST)program,2021-2022

作　　者：李耘[1] 郑波[1] 薛峰[1] 张秀珍[2] 胡云建[2] 金玉芬[3] 赵建宏[4] 潘世扬[5] 郭玮[6] 赵锋[7] 俞云松[7] 蔡璇[8] 刘文恩[9] 刘德华[10] 费樱 刘家云 裴凤艳[13] 孟灵[14] 季萍[15] 汤进[16] 徐凯[17] 朱镭[18] 曹存巍[19] 徐和平[20] 王珊[1] 崔兰卿[1] 张佳[1] 刘姚姚 LI Yun;ZHENG Bo;XUE Feng;ZHANG Xiu-zhen;HU Yun-jan;JIN Yu-fen;ZHAO Jan-hong;PAN Shi-yang;CUO Wei;ZHAO Feng;YU Yun-song;CAI Xuan;LIU Wen-en;LIU De-hua;FEI Ying;LIU Jia-yun;PEI Feng-yan;MENG Ling;JI Ping;TANG Jin;XU Kai;ZHU Lei;CAO Cun-wei;XU He-ping;WANG Shan;CUI Lan-qing;ZHANG Jia;LIU Yao-yao(Institue of Clinical Pharmacology,Peking University First Hospital,Bejing 10034,China;Clinical Laboratory,Beijing Hospital,Beijing 100730,China;Clinical Laboratory,Jilin University Second Hospital,Changchun 130041,Jilin Province,China;Clinical Laboratory,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China;Clinical Laboratory,The First Affiliated Hospital with Nanyjing Medical University,Nanjing 210029,Jiangsu Province,China;a Clinical Laboratory,Zhongshan Hospital Fudan University,Shanghai 20023,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-souh University,Changsha 410008,Hunan Provuince,China;Clinical Laboratorym Kunming First People's Hospital,Kunming 6500l,Yunnan Province,China;Il.Clinical Laboratory,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,Guizhou Province,China;Clinical Laboratory,Air Force Military Medical University Xijing Hospital,Xi'an 710032,Shaanxi Province,China;Clinical Laboratory,Jinan Central Hospital Afiliated 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;I6 Clinical Laboratory,Hanzhong Center Hospital,Hanzhong 723000,Shaanxi Province,China;Clinical Laboratory,Hainan General Hospital,Haikou 57031l,Hainan Province,China;Clinical Laboratory,Children's Hospital of Shanxi,Taiyuan 300012,Shanxi P

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]河北医科大学第二医院检验科,河北石家庄050000 [5]南京医科大学第一附属医院检验科,江苏南京210029 [6]复旦大学中山医院检验科,上海200023 [7]浙江大学邵逸夫医院感染科,浙江杭州310003 [8]武汉大学人民医院检验科,湖北武汉430060 [9]中南大学湘雅医院检验科,湖南长沙410008 [10]昆明市第一人民医院检验科,云南昆明650011 [11]贵州医科大学附属医院检验科,贵州贵阳550001 [12]空军军医大学西京医院检验科,陕西西安710032 [13]济南市中心医院检验科,山东济南250013 [14]兰州大学第二医院检验科,甘肃兰州730030 [15]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 [16]汉中市中心医院检验科,陕西汉中723000 [17]海南省人民医院检验科,海南海口570311 [18]山西省儿童医院检验科,山西太原300012 [19]广西医科大学第一附属医院皮肤科,广西壮族自治区南宁 [20]厦门大学附属第一医院检验科,福建厦门361003

出　　处：《中国临床药理学杂志》2023年第23期3509-3524,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的耐药状况,掌握耐药流行趋势,为抗菌药物合理使用提供科学依据。方法定点收集来自全国19家医院的临床分离细菌,由中心实验室统一采用平皿/肉汤二倍稀释法测定抗菌药物的最低抑菌浓度(MIC)值。结果对2021年7月至2022年6月来自全国19座城市19家医院的1974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36.4%和79.9%。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3.1%和92.9%。万古霉素耐药肠球菌(VRE)检出率为1.6%,利奈唑胺不敏感粪肠球菌比例为32.2%,连续2次监测上升;利奈唑胺不敏感屎肠球菌比例(12.5%)亦明显升高。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0.8%,较前次监测下降近30个百分点,而按口服青霉素V折点计算为71.8%,较之前变化不大,提示青霉素MIC值较高(MIC≥4 mg·L^(-1))菌株数量显著减少。不同病房、不同年龄以及不同标本来源金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、屎肠球菌耐药率比较均无显著性差异。结论VRE检出率稳定在低水平;青霉素MIC值较高的肺炎链球菌较前次监测明显减少;利奈唑胺不敏感肠球菌明显增加,值得注意。Objective To investigate the Gram-positive coccus resistance in nationwide’s tertiary 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.Results A total of 1974 pathogenic Gram-positive coccus from 19tertiary hospitals in 19 cities nationwide over the period from July 2021 to June 2022 were studied.Based on the MIC results,the prevalence of methicillin resistantStapylococcus aureus(MRSA)and methicillin resistantStapylococcus epidermidis(MRSE)were 36.4%and 79.9%respectively.No vancomycin insensitivityStaphylococcuswas detected.Staphylococcus aureuswere 100%susceptibility to linezolid and teicoplanin.Antibiotic resistance rate ofEnterococcus faecalisand Enterococcus faeciumto ampicillin were 3.1%and 92.9%.The detectation rate of vancomycin resistantEnterococcus(VRE)was 1.6%.Nonsusceptibility rate of Enterococcus faecalisto linezolid was 32.2%,two consecutive monitoring rises and nonsusceptibility rate of Enterococcus faecium(12.5%)was also significantly increased.The prevalence of penicillin non-susceptible Streptococcus pneumoniae(PNSSP)was 0.8%based on non-meningitis and parenteral administration criterion,decrease of nearly 30 percentage points from the previous surveillance.While for cases of oral penicillin,the rate was 71.8%,showing similar to last time.The results indicated that the number of strains with higher MIC value of penicillin(MIC≥4 mg·L^(-1))decreased significantly.There were no significant differences of resistance rates of Stapylococcus aureus,Stapylococcus epidermidis,Enterococcus faecalis,Enterococcus faeciumand Streptococcus pneumoniaeamong various groups such as different department,age,or specimen source.Conclusion VRE detection ratio stablized at a relatively low level.The number of Streptococcus pneumoniaewith higher MIC value of penicillin decreased significantly compared with the previous monitoring.The

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]