2018—2020年多中心耐黏菌素病原菌及耐药状况分析

摘要：目的 了解2018—2020年国内不同地区三级医院耐黏菌素临床分离菌株的分布特征及其对其他抗菌药物的药敏 结果。方法 对临床分离的菌株按照统一方案，采用自动化仪器法进行细菌药敏试验，按照美国临床和实验室标准化协会 (Clinical and Laboratory Standards Institute，CLSI)2020年标准判读结果，并采用WHONET 5.6软件进行耐药数据分析。结果 共 收集375株非重复分离的耐黏菌素菌株，主要分离于ICU病区。其中非发酵菌226株，占60.3%；肠杆菌目149株，占39.7%。从菌 株分布来看，排名前3位的依次是铜绿假单胞菌46.1%(173/375)、肺炎克雷伯菌20.3%(76/375)、鲍曼不动杆菌14.1%(53/375)。从 药敏结果来看，耐黏菌素菌的MIC值主要分布在4~32μg/mL。其中非发酵菌对黏菌素耐药的MIC值主要集中在4和32μg/mL，肠 杆菌目对黏菌素耐药的MIC值主要集中在4μg/mL；耐黏菌素的铜绿假单胞菌对氨基糖苷类和哌拉西林/他唑巴坦仍保持一定的抗 菌活性，耐药率均<25%，而耐黏菌素的肺炎克雷伯菌和鲍曼不动杆菌对替加环素外的其他抗菌药物呈现高度耐药性，两者对碳 青霉烯类抗生素耐药率分别为82.8%和79.2%。 结论 黏菌素耐药菌株尤其是高水平耐药株已在不同地区出现，临床应引起重 视，合理使用抗菌药物。

Multicenter analysis of colistin-resistant clinical isolates and antimicrobial resistance in 2018-2020

Abstract Objective To investigate the distribution characteristics of colistin-resistant clinical isolates and their sensitivity to antibiotics in tertiary hospitals in different regions of China from 2018 to 2020. Methods According to the unified scheme, the bacterial drug sensitivity test was carried out by automated systems, the results were interpreted according to CLSI 2020 and the WHONET5.6 software was used for data analysis. Results A total of 375 colistin-resistant strains were collected, which were mainly isolated from ICU. Among them, there were 226 strains of non-fermentative bacteria (60.3%) and 149 strains of Enterobacteriaceae (39.7%). In terms of strain distribution, the top three were Pseudomonas aeruginosa (46.1%), Klebsiella pneumoniae (20.3%), Acinetobacter baumannii (14.1%). From the results of drug sensitivity, the MIC of colisitin-resistant bacteria was mainly distributed in the range of 4~32μg/mL. Among them, the MIC values of colistin resistance of non-fermentative bacteria were mainly concentrated at 4 and 32μg/mL, and those of Enterobacteriaceae to colistin were mainlyconcentrated at 4μg/mL. Colistin-resistant Pseudomonas aeruginosa still maintained certain antibacterial activity to aminoglycosides and piperacillin/tazobactam, and the resistance rates were less than 25%. Colistin-resistant Klebsiella pneumonia and Acinetobacter baumannii showed high-level resistance to antibiotics other than tegacycline, and the resistance rates to carbapenem antibiotics were 82.8% and 79.2%, respectively. Conclusion Colistin-resistant strains, especially the high-level of drug-resistant strains, have emerged in different areas, which should be paid attention in clinic and rational use of antibiotics.