2020-2021年中国10所教学医院院内感染常见病原菌分布和耐药监测  

Distribution and resistance surveillance of common pathogens of nosocomial infections in 10 teaching hospitals in China from 2020 to 2021

作　　者：李曙光[1] 鲁炳怀 褚云卓[3] 张嵘[4] 曾吉[5] 苏丹虹[6] 卓超[7] 金炎[8] 徐修礼 廖康[10] 胡志东[11] 王辉[1] Li Shuguang;Lu Binghuai;Chu Yunzhuo;Zhang Rong;Zeng Ji;Su Danhong;Zhuo Chao;Jin Yan;Xu Xiuli;Liao Kang;Hu Zhidong;Wang Hui(Department of Clinical Laboratory,Peking University People′s Hospital,Beijing 100044,China;Laboratory of Clinical Microbiology and Infectious Diseases,Department of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Clinical Laboratory,the First Hospital of China Medical University,Shenyang 110001,China;Department of Clinical Laboratory,the Second Affiliated Hospotal of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Clinical Laboratory,Puai Hospital of Tongji Medical College of Huazhong University of Science&Technology,Wuhan 430033,China;Department of Clinical Laboratory,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;State Key Laboratory of Respiratory Disease,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Clinical Laboratory,Shandong Provincial Hospital,Jinan 250021,China;Department of Clinical Laboratory,Xijing Hospital of Air Force Military Medical University,Xi′an 710032,China;Department of Clinical Laboratory,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Clinical Laboratory,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]北京大学人民医院检验科,北京100044 [2]中日友好医院呼吸与危重症医学科二部临床微生物与感染实验室,北京100029 [3]中国医科大学附属第一医院检验科,沈阳110001 [4]浙江大学医学院附属第二医院检验科,杭州310009 [5]华中科技大学同济医学院附属普爱医院检验科,武汉430033 [6]广州医科大学附属第一医院检验科,广州510120 [7]广州医科大学附属第一医院呼吸疾病国家重点实验室,广州510120 [8]山东省立医院检验科,济南250021 [9]空军军医大学西京医院检验科,西安710032 [10]中山大学附属第一医院检验科,广州510080 [11]天津医科大学总医院医学检验科,天津300052

出　　处：《中华检验医学杂志》2024年第6期619-628,共10页Chinese Journal of Laboratory Medicine

摘　　要：目的监测2020—2021年我国引起院内感染的主要病原菌的病原谱分布和对主要抗菌药物的敏感性。方法回顾性收集来自我国10家教学医院的引起院内血流感染(BSI,670株)、医院获得性肺炎(HAP,394株)和院内腹腔感染(IAI,247株)的病原菌1311株。经中心实验室复核菌株后,对临床常见菌株进行抗菌药物药敏试验,采用琼脂稀释法或微量肉汤稀释法测定菌株的最低抑菌浓度(MIC),药敏折点采用美国临床和实验室标准协会2023年M100(第33版)标准。使用χ^(2)检验进行率的比较。结果BSI最主要的致病菌是大肠埃希菌(21.2%,142/670)、肺炎克雷伯菌(14.9%,100/670)和金黄色葡萄球菌(11.5%,77/670);HAP最主要致病菌是肺炎克雷伯菌(27.7%,109/394)、鲍曼不动杆菌(22.1%,87/394)和铜绿假单胞菌(18.3%,72/394);IAI最主要的致病菌是大肠埃希菌(24.3%,60/247)、屎肠球菌和肺炎克雷伯菌(均为14.6%,36/247)。金黄色葡萄球菌对替加环素、利奈唑胺、达托霉素和糖肽类抗菌药物均表现为敏感。甲氧西林耐药的金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的检出率分别为36.5%(42/115)和74.5%(38/51)。屎肠球菌和粪肠球菌对万古霉素的耐药率分别为3.3%(3/90)和1.9%(1/53)。肺炎克雷伯菌和大肠埃希菌中超广谱β内酰胺酶的检出率分别为23.7%(58/245)和60.5%(130/215),碳青霉烯耐药株的检出率分别为29.8%(73/245)和4.2%(9/215),对替加环素的耐药率分别为1.6%(4/245)和0,对黏菌素的耐药率分别为1.6%(4/245)和2.8%(6/215),对头孢他啶/阿维巴坦的耐药率分别为2.0%(5/245)和2.3%(5/215)。鲍曼不动杆菌除对黏菌素(98.8%,161/163)和替加环素(89.6%,146/163)表现出较高的敏感性,对其他抗菌药物均表现出较高的耐药率,碳青霉烯耐药株的检出率达到76.7%(125/163)。碳青霉烯耐药的铜绿假单胞菌检出率为28.4%(33/116);黏菌素、阿米卡星和头孢他啶/阿维巴坦对铜绿假单胞菌表现�Objective To investigate the spectrum and antimicrobial resistance of major pathogens causing nosocomial infections in China during 2020-2021.Methods A total of 1311 non-duplicated nosocomial pathogens causing bloodstream infections(BSI,n=670),hospital-acquired pneumonia(HAP,n=394)and intra-abdominal infections(IAI,n=297)were collected from 10 teaching hospitals across China.The minimum inhibitory concentrations(MICs)of clinical common strains were determined using agar dilution or broth microdilution method.Interpretation of reults followed the CLSI M100-Ed33 criteria,with data analysis conducted using WHONET-5.6 software.The Chi-square test was used to compare rates.Results The most prevalent pathogens causing BSI were Escherichia coli(21.2%,142/670),Klebsiella pneumoniae(14.9%,100/670)and Staphylococcus aureus(11.5%,77/670);the most prevalent pathogens causing HAP were K.pneumoniae(27.7%,109/394),Acinetobacter baumanii(22.1%,87/394)and Pseudomonas aeruginosa(18.3%,72/394).IN IAI,E.coli(24.3%,60/247),Enterococcus faecium and K.pneumoniae(both 14.6%,36/247)were dominated.All S.aureus strains were susceptible to tigecycline,linezolid,daptomycin and glycopeptides.Rates of methicillin-resistant S.aureus(MRSA)and coagulase-negative Staphylococcus(MRCNS)were 36.5%(42/115)and 74.5%(38/51),respectively.The rate of vancomycin-resistant E.faecium and E.faecalis was 3.3%(3/90)and 1.9%(1/53),respectively.The prevalence of extended-spectrumβ-lactamase(ESBL)was 23.7%(58/245)in K.pneumonia and 60.5%(130/215)in E.coli.The rate of carbapenem-resistant K.pneumonia and E.coli was 29.8%(73/245)and 4.2%(9/215),respectively;the percentage of tigecycline-resistant K.pneumonia and E.coli was 1.6%(4/245)and 0,respectively;the rate of colistin-resistant K.pneumonia and E.coli was 1.6%(4/245)and 2.8%(6/215),respectively;the percentage of ceftazidime/avibactam-resistant K.pneumonia and E.coli was 2.0%(5/245)and 2.3%(5/215),respectively.The rate of carbapenem-resistant A.baumanii and P.aeruginosa was 76.7%(125/163)and 28.4%(33/116),respec

关 键 词：医院内感染 细菌感染 血流感染 医院获得性肺炎 腹腔感染 抗菌药物 药敏试验 耐药性 

分 类 号：R446.5[医药卫生—诊断学]