2019年CHINET三级医院细菌耐药监测

目的监测国内主要地区医疗机构临床分离菌对抗菌药物的敏感性。方法对国内主要地区36所三级医院临床分离菌采用纸片扩散法或自动化仪器法按CHINET统一监测方案进行抗菌药物敏感性试验。按CLSI文件标准判断结果。结果收集2019年1-12月上述医院临床分离菌共249 758株,其中革兰阳性菌占29.0%,革兰阴性菌占71.0%。金黄色葡萄球菌、表皮葡萄球菌和其他凝固酶阴性葡萄球菌(除假中间葡萄球菌和施氏葡萄球菌)中甲氧西林耐药株的检出率分别为31.4%、82.4%和78.3%。甲氧西林耐药株(MRSA、MRSE和MRCNS)对绝大多数抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA、MSSE和MSCNS)。MRSA中有92.6%的菌株对甲氧苄啶-磺胺甲噁唑敏感;MRSE中有89.0%的菌株对利福平敏感;未发现万古霉素耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株。2019年儿童和成人中分离的肺炎链球菌中PSSP(95.2%和95.3%)所占比例较2018年有所上升,PISP和PRSP的检出率有所下降。除肺炎克雷伯菌对碳青霉烯类的耐药率为27.6%外,肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于10%。2005-2019年15年的监测数据显示肺炎克雷伯菌对亚胺培南和美罗培南的耐药率呈持续上升趋势(3.0%和2.9%对25.3%和26.8%)。此外,不动杆菌属对亚胺培南和美罗培南的耐药率分别为73.6%和75.1%;铜绿假单胞菌对上述两药的耐药率分别为27.5%和23.5%。结论临床分离菌对常用抗菌药物的耐药率仍呈增长趋势,尤其是碳青霉烯类耐药革兰阴性杆菌。为应对严峻的全国细菌耐药形势,需各相关部门协作以遏制细菌耐药。

CHINET surveillance of bacterial resistance across tertiary hospitals in 2019

Objective To investigate the antimicrobial resistance profiles of the clinical strains isolated from tertiary hospitals across several regions of China.Methods These clinical strains were collected from 36 tertiary hospitals.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI breakpoints.Results A total of 249 758 clinical isolates were collected from January to December 2019,of which gram negative organisms and gram positive cocci accounted for 71.0% and 29.0%,respectively.Methicillin-resistant strains accounted for 31.4% in S.aureus (MRSA),82.4% in S.epidermidis and 78.3% in other Staphylococcus species (except S.pseudintermedius and S.schleiferi).The MR strains showed much higher resistance rates to most of the antimicrobial agents tested than MS strains.However,92.6% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 89.0% of MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin.E.faecalis strains demonstrated much lower resistance rates to most of the drugs tested than E.faecium.A few strains of both species were resistant to vancomycin.The prevalence of PSSP was 95.2% in the S.pneumoniae strains isolated from children and 95.3% in the isolates from adults,which were higher than the prevalence in 2018,while the prevalence of PISP and PRSP was lower than that in 2018.The strains of Enterobacteriaceae were still highly susceptible to carbapenems.Overall,less than 10% of these strains were resistant to carbapenems,except K.pneumoniae isolates,27.6% of which were resistant to carbapenems.The results of 15-year surveillance from 2005 to 2019 showed a remarkable increase of imipenem resistance from 3.0% to 25.3% and meropenem resistance from 2.9% to 26.8% in K.pneumoniae isolates.About 73.6% and 75.1% of Acinetobacter spp.strains were resistant to imipenem and meropenem,respectively.The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 27.5% and 23.5%,respectively.Conclusions Bacterial resistance to commonly used antibiotics is still on the rise,especially for carbapenem-resistant gram-negative bacilli.It is necessary to strengthen the collaboration among different departments to combat the bacterial resistance.