全国细菌耐药监测网2014—2019年尿标本细菌耐药监测报告

目的探讨全国尿标本分离细菌菌种分布及耐药变迁。方法按照全国细菌耐药监测网(CARSS)技术方案,应用WHONET5.6软件对2014—2019年所有CARSS成员单位上报的尿标本分离细菌及药敏结果数据进行分析。结果男性患者尿标本分离细菌居前5位者分别为大肠埃希菌(33.1%~34.6%)、粪肠球菌(9.2%~10.2%)、肺炎克雷伯菌(9.0%~9.4%)、屎肠球菌(7.8%~10.2%)和铜绿假单胞菌(5.6%~6.9%),女性患者尿标本分离细菌居前5位者分别为大肠埃希菌(57.0%~57.4%)、肺炎克雷伯菌(7.5%~8.3%)、屎肠球菌(6.8%~8.7%)、粪肠球菌(5.5%~6.0%)和奇异变形杆菌(3.3%~3.5%)。男性和女性患者尿标本分离粪肠球菌对氨苄西林和呋喃妥因耐药率分别<12%和7%,对万古霉素耐药率<3%;屎肠球菌对氨苄西林、左氧氟沙星耐药率均为90%左右,对万古霉素耐药率<4%。大肠埃希菌对头孢曲松耐药率>47%,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、呋喃妥因耐药率≤8%,对于β-内酰胺类耐药率男性比女性高,其中头孢曲松的耐药率高12个百分点左右。男性患者分离肺炎克雷伯菌对头孢曲松耐药率为58%左右,女性患者耐药率为45%左右。男性和女性患者尿标本分离铜绿假单胞菌对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率均<14%,对碳青霉烯类耐药率为15%左右。鲍曼不动杆菌对头孢哌酮/舒巴坦和米诺环素耐药率分别<27%和22%,对碳青霉烯类耐药率,男性为31.7%~47.7%,女性为26.5%~41.2%。结论尿标本分离细菌在不同性别构成上有所不同,且部分肠杆菌目细菌耐药率不同性别间也有一定差异,不同年度间部分细菌的耐药率也有一定变化。尿标本分离细菌的耐药监测,可为尿路感染抗菌药物合理应用提供参考数据。

Antimicrobial resistance of bacteria from urine specimens: surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019

Objective To investigate the change in distribution and antimicrobial resistance of bacteria isolated from urine specimens in China. Methods According to the technical program of China Antimicrobial Resistance Surveillance System (CARSS), data of bacteria isolated from urine specimens and antimicrobial susceptibility testing results reported by all CARSS member hospitals from 2014 to 2019 were analyzed by WHONET5.6 software. Results The top 5 bacteria isolated from urine specimens of male patients were Escherichia coli (33.1%-34.6%), Enterococcus faecalis (9.2%-10.2%), Klebsiella pneumoniae (9.0%-9.4%), Enterococcus faecium (7.8%-10.2%) and Pseudomonas aeruginosa (5.6%-6.9%), the top 5 bacteria isolated from urine specimens of female patients were Escherichia coli (57.0%-57.4%), Klebsiella pneumoniae (7.5%-8.3%), Enterococcus faecium (6.8%-8.7%), Enterococcus faecalis (5.5%-6.0%) and Proteus mirabilis (3.3%-3.5%). Resis-tance rates of Enterococcus faecalis from urine specimens of male and female patients to ampicillin and nitrofurantoin were <12% and 7% respectively, to vancomycin was <3%; resistance rates of Enterococcus faecium to ampicillin and levofloxacin were both about 90%, to vancomycin were <4%. Resistance rates of Escherichia coli to ceftria-xone were>47%, to cefoperazone/sulbactam, piperacillin/tazobactam, and nitrofurantoin were all ≤8%, resis-tance rate to β-lactams in male patients was higher than in female patients, resistance rate to ceftriaxone was about 12 percentage higher. Resistance rates of Klebsiella pneumoniae isolated from male and female patients to ceftria-xone were about 58% and about 45% respectively. Resistance rates of Pseudomonas aeruginosa isolated from urine specimens of male and female patients to cefoperazone/sulbactam and piperacillin/tazobactam were both <14%, resistance rates to carbapenems were about 15%. Resistance rates of Acinetobacter baumannii to cefoperazone/sulbactam and minocycline were <27% and <22% respectively, resistance rates to carbapenems were 31.7%-47.7% in males and 26.5%-41.2% in females. Conclusion Constituent of bacteria isolated from urine specimens is different in different genders, antimicrobial resistance rates of partial Enterobacteriaceae are different among different genders, resistance rates of partial bacteria also changed in different years. Surveillance on antimicrobial resistance of bacteria isolated from urine specimens can provide reference data for the rational use of antimicrobial agents in urinary tract infection.