我国2017—2023年新德里金属β⁃内酰胺酶阳性耐药菌流行现状分析  

Analysis of the prevalence of New Delhi metallo⁃β⁃lactamase⁃positive drug⁃resistant bacteria in China from 2017 to 2023

作　　者：李可馨 肖杨 陈明亮 王盛书 王博千 彭芷溪 梁胜男 任洪广 宋宏彬 胡晓丰 LI Kexin;XIAO Yang;CHEN Mingliang;WANG Shengshu;WANG Boqian;PENG Zhixi;LIANG Shengnan;REN Hongguang;SONG Hongbin;HU Xiaofeng(China Medical University,Shenyang 110122,China;Chinese PLA Center for Disease Control and Prevention,Beijing 100071,China;School of Medicine,Chongqing University,Chongqing 400030,China;School of Military Preventive Medicine,Army Medical University,Chongqing 400038,China;The Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Academy of Military Medical Sciences,Academy of Military Sciences,Beijing 100071,China)

机构地区：[1]中国医科大学,沈阳110122 [2]解放军疾病预防控制中心,北京100071 [3]重庆大学医学院,重庆400030 [4]陆军军医大学军事预防医学系,重庆400038 [5]解放军总医院第二医学中心,北京100853 [6]军事科学院军事医学研究院,北京100071

出　　处：《军事医学》2024年第12期907-913,共7页Military Medical Sciences

基　　金：国家自然科学基金项目(82003519);北京市自然科学基金项目(7232229)。

摘　　要：目的综合分析我国新德里金属β-内酰胺酶(NDM)阳性耐药菌的流行病学特征及耐药机制。方法在中国知网和PubMed数据库中检索国内发现NDM阳性耐药菌的相关文献(发表时间为2017年1月1日至2023年12月31日),对NDM阳性耐药菌菌株种类与地区分布、感染来源、耐药率和转移机制进行流行病学分析。结果共筛选符合条件的文献118篇,报道NDM阳性耐药菌1627株,2011—2019年,报道数量逐年递增,2020年开始逐年下降;NDM-1与NDM-5阳性菌数量居多;地区分布以华东地区报道数量最多,其次为华中、华北地区;NDM阳性耐药菌主要为肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌;NDM阳性耐药菌感染患者年龄特征较为明显,新生儿与儿童、50岁以上的患者分别占27.25%和49.57%。NDM阳性耐药菌主要来源于痰(38.28%)、尿(28.94%)和血液(23.28%);科室来源主要为ICU(39.93%)、儿科(20.14%);NDM阳性耐药菌对绝大多数抗生素耐药性超过50.00%,仅对黏菌素、替加环素等耐药性差(低于30.00%);携带blaNDM基因的质粒型主要为IncX3,且blaNDM基因上下游存在的插入序列呈多样性。结论NDM阳性耐药菌在我国多个地区广泛流行,且表现出多重耐药,给临床抗生素的选择带来较大困难和挑战,亟待提出有效应对措施。Objective To comprehensively analyze the epidemiological characteristics and resistance mechanisms of New Delhi metallo-β-lactamase(NDM)-positive multidrug-resistant bacteria in China.Methods Relevant literatures on NDM-positive multidrug-resistant bacteria discovered in China were searched in the CNKI and PubMed databases(publications from January 1,2017 to December 31,2023).The epidemiological analysis was conducted on the types of NDM-positive bacterial strains,their regional distribution,infection sources,resistance profiles,and transfer mechanisms.Results A total of 118 eligible articles were collected,reporting 1627 NDM-positive bacterial strains.The number of reports increased annually from 2011 to 2019,but began to decline annually from 2020 onwards.NDM-1 and NDM-5 were the most commonly reported variants.The highest number of reports came from Eastern China,followed by Central China and North China.The primary pathogens were Klebsiella pneumoniae,Escherichia coli,and Enterobacter cloacae.The age distribution of patients with NDM-positive infections showed distinct patterns,with neonates and children accounting for 27.25%and patients over 50 years old accounting for 49.57%.The majority of positive bacterial infections came from sputum(38.28%),urine(28.94%),and blood(23.28%).The main departments reporting NDM-positive bacteria were the ICU(39.93%)and pediatrics(20.14%).These resistant bacteria exhibited resistance to more than 50.00%of antibiotics,with lower resistance to colistin and tigecycline(below 30.00%).The predominant plasmid type carrying the blaNDMwas IncX3,and the insertion sequences upstream and downstream of the blaNDM showed diversity.Conclusion NDM-positive multidrug-resistant bacteria are widely prevalent across regions in China,exhibiting multidrug-resistance.This poses significant challenges to clinical antibiotic selection and necessitates the development of effective countermeasures.

关 键 词：新德里金属β-内酰胺酶 流行特征 耐药谱 

分 类 号：R181.3[医药卫生—流行病学]