摘要
目的对四川省细菌耐药监测网成员单位2016年度细菌分布及耐药情况进行统计分析,为本省临床合理应用抗菌药物提供依据。方法按照监测方案,采用标准纸片扩散法或自动化仪器检测法,依据CLSI 2016年标准,用WHONET 5.6软件进行数据分析。结果共有75家医院参加了2016年度细菌耐药监测工作,其中数据基本合格纳入分析的共71家。按患者首次分离菌株进行统计分析,共收集细菌169277株,其中革兰阴性菌121190株(71.6%),革兰阳性菌48087株(28.4%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为26.2%和80.5%,MRSA检出率较2015年有所下降而MRCNS有所上升,未发现万古霉素、利奈唑胺和替考拉宁不敏感的葡萄球菌。万古霉素耐药粪肠球菌和屎肠球菌分别占0.4%和3.1%,利奈唑胺耐药粪肠球菌和屎肠球菌分别占1.5%和0.5%。非脑脊液中分离的肺炎链球菌对青霉素的耐药率为3.6%。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌分别为37030株(30.6%)、22770株(18.8%)和14360株(11.8%),为革兰阴性菌分离率前3位。大肠埃希菌对喹诺酮类耐药率在45%左右,对第三代头孢菌素中的头孢噻肟和头孢曲松的耐药率均在55.0%左右。肺炎克雷伯菌对抗菌药物的耐药模式基本与大肠埃希菌相似,但耐药率稍低,对头孢第三代抗菌药物耐药率低于30.0%,喹诺酮类药物对肺炎克雷伯菌仍保持较高的抗菌活性,敏感率仍约80%。大肠埃希菌和肺炎克雷伯菌对碳青酶烯类抗生素耐药率分别为1.1%和2.9%,与2015年相比无明显增长。铜绿假单胞菌对碳青酶烯类的耐药率低于15%,对氨基糖苷类、哌拉西林/三唑巴坦、多黏菌素B、头孢吡肟、头孢哌酮/舒巴坦、头孢他啶仍保持较高的抗菌活性。除米诺环素和头孢哌酮/舒巴坦,鲍曼不动杆菌对碳青霉烯类等药物耐药率超过50.0%,其中亚胺培南和美罗培南的耐药率分别为63.1%和65.1%,高于全国平均水平。结论我省细菌耐药呈缓慢增长趋势,重要及特殊耐药菌检出率与2015年无显著变化,但省内不同区域的细菌多重耐药率有明显差异,个别地区处于较高水平,应充分利用本地细菌耐药监测结果进行感控管理,促进抗菌药物合理应用。
Objective To analyze the distribution and drug resistance of bacterial in 2016 from the members of Antimicrobial Resistant Investigation Net of Sichuan province, and to guide the rational use of antimicrobial drugs. Methods According to the monitoring scheme and standard of CLSI2016, analyzed the susceptibility data by software WHONET 5.6 which was detected with the method of disc-diffusion or automatic clinical microbiological systems. Results There were 75 hospitals participating in the antimicrobial resistant investigation and 71 of them were basically qualified to be included. According to the patient＇s first separation strain, 169,277 bacterial isolates and their antibacterial susceptibility data were collected, which included 121,190 （71.6%） Gram-negative bacterial isolates and 48087（28.4%） Gram-positive bacterial isolates. The isolating rates of methicillin-resistant Staphylococcus aureus （MRSA） and methicillin-resistant coagulase negative Staphylococcus （MRCNS） were 26.2% and 80.5%, respectively, the detection rate of MRSA have declined from 2015 and MRCNS rose, no vancomycin and linezolid non-sensitive Staphylococcus isolates were found. There were 0.4% E. faecalis and 3.1% E. faecium resistant to vancomycin, which were 1.5% and 0.5% resistant to linezolid. Penicillin-resistant Streptococcus pneumoniae were found about 3.6%. The top three rank of Gram-negative bacterial isolates were E. coli （37030 isolates, 30.6%）, K. pneumoniae （22770 isolates, 18.8%）, P. aeruginosa （14360isolates, 11.8%）, the E. coli whose resistance rate to quinolones was above 45.0% and that were both above 55.0% to cefotaxime and ceftriaxone. Drug resistance mechanism ofK. pneumoniae is basically similar to Eseherichia coli. It has a slightly lower resistance, for example, the drug resistance to the third generation cephalosporin is lower than 30.0%. Carbostyrils maintain a relatively higher anti-bacterial activity for K. pneumoniae which sensiivety is around 80%, E. coli and K. pneumoniae had an antibiotic resistance rate of 1.1% and 2.9%, which is no significant incerase comparing to 2015. The drug resistance of P. aeruginosa towards carbapenems is lower than 15%. The drug resistance of P. aeruginosa to carbapenems is lower than 15%, while the resistance to aminoglycoside, piperacillin/tazobactam, polymyxin B, cefepime, cefoperazone/sulbactam and ceftazidime is relatively high. Except for minocyline and cefoperazone/sulbactam, drug resistance of A. baumannii to arabapenems is above 50.5%, including 63.1% to imipenem and 65.1% to meropenem, which are higher than the national average. Conclusion The drug resistance of bacteria in our province displays a gradual incresing tendency, the detection rates of important and special drug resistant strains have no significant change to the date of 2015. However, there is significant differerce in multi-drug resistant rate in bacteria from different intra-provicial regions, and the rates in some areas are in higher levels. We should fully use bacterial drug resistance surveillance results for supervision and administration, and to take effective measures for the control of the spread of resistant isolates.
作者
殷琳
喻华
黄湘宁
张欣
龙姗姗
刘鑫
Yin Lin;Yu Hua;Huang Xiang-ning;Zhang Xin;Long Shan-shan;Liu Xin(Department of Clinical Laboratory,Sichuan Academy of Medical Sciences,Sichuan Provincial People＇s Hospital,Chengdu 610072)
出处
《中国抗生素杂志》
CAS
CSCD
2018年第10期1271-1280,共10页
Chinese Journal of Antibiotics
关键词
细菌耐药性监测
耐药率
细菌感染
Bacterial resistance surveillance
Resistance rate
Bacterial infection
