中国细菌耐药监测研究(CARST)2021—2022年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,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-jian;JIN Yu-fen;ZHAO Jian-hong;PAN Shi-yang;GUO Wei;ZHAO Feng;YU Yun-song;CAI Xuan;LIU Wen-en;LIU De-hua;FEI Ying;LIU Jia-yun;PEI Feng-yan;MENG Ling;Jl Ping;TANG Jin;XU Kai;ZHU Lei;CAO Cun-wei;XU He-ping;WANG Shan;CUI Lan-qing;ZHANG Jia;LIU Yao-yao(Institute of Clinical Pharmacology,Peking University First Hospital,Beijing 10034,China;Clinical Laboratory,Beijing Hospital,Bejing 100730,China;Clinical Laboratory,Jilin University Second Hospital,Changchun 130041,Jilin Province,China;Clinical Laboratory,The Second Hospital of Hebei Medical University,Shijiazhuang 05000,Hebei Province,China;Clinical Laboratory,The First Affliated Hospital with Nanjing Medical University,Nanjing 210029,Jiangsu Province,China;Clinical Laboratory,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 University,Changsha 410008,Hunan Province,China;Clinical Laboratorym Kunming First People's Hospital,Kunming 650oll,Yunnan Province,China;Il.Clinical Laboratory,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,Guizhou Province,China;Clinical Laboratory,Air Force Military Medical Universiy Xijing Hospital,Xi'an 710032,Shaani 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,Shaanai Province,China;Clinical Laboratory,Hainan General Hospital,Haikou 57031l,Hainan Province,China;Clinical Laboratory,Children's Hospital of Shanxi,Taiyuan 300012,Shanxi Pro

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3525-3544,共20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阴性菌耐药状况,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4066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55.0%和21.0%,肺炎克雷伯菌ESBLs表型检出率继续下降,碳青霉烯类耐药肺炎克雷伯菌比例则较前次监测上升5个百分点。对肠杆菌目细菌抗菌作用较好的药物包括碳青霉烯类、拉氧头孢、西他沙星、β内酰胺合剂、磷霉素氨丁三醇、阿米卡星等,细菌敏感率在75%以上。此外,替加环素、奥玛环素、黏菌素和氟氧头孢对各自有效菌属/种保持很好的抗菌活性,细菌敏感率>80%。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26.3%和72.1%,多重耐药菌(MDR)检出率分别为41.1%和77.3%,泛耐药菌(XDR)检出率分别为12.0%和71.8%。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(ICU)分离肺炎克雷伯菌、鲍曼不动杆菌耐药率较非ICU分离菌显著升高,ICU分离肺炎克雷伯菌碳青霉烯类耐药率>35%;儿童分离流感嗜血杆菌对β内酰胺类、大环内酯类、克林霉素耐药率以及肺炎克雷伯菌中ESBLs检出率高于成人和老年人,儿童细菌耐药问题不容忽视。结论大肠埃希菌ESBLs检出率经多年持续下降后略有回升;碳青霉烯类耐药铜绿假单胞菌比例稳定,但肺炎克雷伯菌、鲍曼不动杆菌对碳青霉烯类耐药率仍有升高,值得注意。Objective To investigate the Gram-negative bacteria 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.Results A total of 4066 pathogenic isolates from 19 tertiary hospitals in 19 cities nationwide over the period from July 2021 to June 2022 were studied.Based on the MIC results,Escherichia coliandKlebsiella pneumoniae showed extended spectrumβ-lactamase(ESBLs)phenotype rates of55.0%and 21.0%,respectively,ESBLs phenotype rate ofKlebsiella pneumoniaekeep going down.The ratios of carbapenems resistance Klebsiella pneumoniaeincreased by 5 percentage points compared with the previous monitoring.Carbapenems,moxalactam,sitafloxacin,β-lactam combination agents,fosfomycin trometamol,and amikacin displayed desirable antibacterial activity againstEnterbacterales,susceptibal rates were above 75%.In addition,tigacycline,omacycline,colistin and fluoxefin maintained good antibacterial activity against their respective effective bacteria/species,and the bacterial sensitivity rates by more than 80%.Resistance rates ofPseudomonas aeruginosaandAcinetobacter baumannnii to imipenem were 26.3%and 72.1%and multidrug-resistant(MDR)detection rates were 41.1%and 77.3%,extensively drug-resistant(XDR)were 12.0%and 71.8%,respectively.Comparison of drug resistance rates from different wards,ages and specimen sources indicated that the proportion of resistance inKlebsiella pneumoniaeand Acinetobacter baumanniiisolated from intensive care unit(ICU)were significantly higher than non-ICU.Carbapenem resistance rates ofKlebsiella pneumoniaeisolated from ICU were more than 35%.Resistance rates ofHaemophilus influenzaeisolated in children toβ-lactam,macrolide,clindamycin and ESBLs detection rate inKlebsiella pneumoniae isolated from children were more than those from adults and the old people,so bacterial resistance in children is

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]