摘要
目的了解2020—2024年全国临床标本常见病原菌分布及耐药性,为临床抗菌药物合理应用,以及政府及时掌握全国细菌耐药形势,制定和评价抗菌药物临床应用管理政策提供科学依据。方法按照全国细菌耐药监测网(CARSS)技术方案,采用WHONET 5.6软件对2020—2024年CARSS上报的所有分离菌耐药性进行分析。结果全国三级医院革兰阳性菌排名居前5位的依次是金黄色葡萄球菌、屎肠球菌、粪肠球菌、表皮葡萄球菌和肺炎链球菌,二级医院居前5位的依次是金黄色葡萄球菌、肺炎链球菌、粪肠球菌、表皮葡萄球菌和屎肠球菌。二级医院肺炎链球菌分离率高于三级医院。2020—2024年CARSS革兰阴性菌分离占比居前5位的依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和阴沟肠杆菌,2024年三级医院和二级医院的流感嗜血杆菌分离率位于第5位。三级医院中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)检出率有所下降,三级医院和二级医院中耐万古霉素屎肠球菌(VREM)检出率有所增加。不同等级医院中耐碳青霉烯铜绿假单胞菌(CRPAE)的检出率有所下降,耐碳青霉烯鲍曼不动杆菌(CRABA)的检出率变化不明显,同期比较,三级医院的检出率均高于二级医院。耐头孢噻肟大肠埃希菌和肺炎克雷伯菌检出率有所下降,但同期比较,三级医院高于二级医院。耐亚胺培南和美罗培南大肠埃希菌检出率变化不大,且均<1.8%;肺炎克雷伯菌对亚胺培南和美罗培南的耐药率有所降低,三级医院中对亚胺培南和美罗培南的耐药率高于二级医院。流感嗜血杆菌对大部分抗菌药物的耐药率有所上升,同期比较,三级医院高于二级医院。结论三级医院中MRSA、MRCNS的检出率有所下降,二级医院则变化不明显。三级医院和二级医院中VREM的检出率均有所增加。三级医院碳青霉烯耐药的肺炎克雷伯菌(CRKPN)的检出率仍保持较高水平,且三级医院高于二级医院。不同等级医院中鲍曼不动杆菌对各抗菌药物的耐药性严重,流感嗜血杆菌对多种抗菌药物的耐药率均有所上升。应持续加强抗菌药物合理应用的管理及医院感染防控,切实做好耐药监测工作。
ObjectiveTo investigate the distribution and antimicrobial resistance of common pathogens from clinical specimens nationwide in 2020-2024,provide scientific basis for clinical rational application ofantimicrobial agents,as well as for the government to timely grasp the antimicrobial resistance situation nationwide,formulate and evaluate clinical application management policies for antimicrobial agents.MethodsAccording to the technical scheme of China Antimicrobial Resistance Surveillance System(CARSS),antimicrobial resistance of all bacterial isolates reported by CARSS in 2020-2024 were analyzed with WHONET 5.6 software.ResultsThe top 5 isolated Gram-positive bacteria from tertiary hospitals nationwide were Staphylococcus aureus,Enterococcus faecium.Enterococcus faecalis,Staphylococcus epidermidis,and Streptococcus pneumoniae.The top 5 isolated Gram-positive bacteria from secondary hospitals were Staphylococcus aureus,Streptococcus pneumoniae,Enterococcus faecalis,Staphylococcus epidermidis,and Enterococcus faecium.Isolation rate of Streptococcus pneumoniae from secondary hospitals was higher than that from tertiary hospitals.The percentage of top 5 isolated Gram-negative bacteria in 2020-2024 were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,and Enterobacter cloacae.In 2024,the isolation rate of Haemophilus influenzae in tertiary and secondary hospitals ranked the fifth.Detection rates of methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant coagulase negative Staphylococcus(MRCNS)have decreased in tertiary hospitals.Detection rates of vancomycin-resistant Enterococcus faecium(VREM)increased in tertiary and secondary hospitals.The detection rates of carbapenem-resistant Pseudomonas aeruginosa(CRPAE)decreased in hospitals of different levels,while those of carbapenem-resistant Acinetobacter baumannii(CRABA)showed no significant changes:in the same period,the detection rates of both pathogens in tertiary hospitals were higher than those in secondary hospitals.Detection rates of cefotaxime-resistant Escherichia coli and Klebsiella pneumoniae have declined,but both were higher in tertiary hospitals than in secondary hospitals during the same period.Detection rates of imipenem-and meropenem-resistant Escherichia coli didn't change much and both were lower than 1.8%;Resistance rates of Klebsiella pneumoniae to imipenem and meropenem decreased,with tertiary hospitals having a significantly higher resistance rate to imipenem and meropenem than secondary hospitals.Resistance rates of Haemophilus influenzae to most antimicrobial agents increased,and that from tertiary hospitals were higher than from secondary hospitals during the same period.Conclusion The detection rates of MRSA and MRCNS have decreased in tertiary hospitals,whereas the changes in secondary hospitals remain insignificant.The detection rates of VREM have increased in both tertiary and secondary hospitals.In tertiary hospitals,the detection rate of CRKPN(carbapenem-resistant Klebsiella pneumoniae)remains at a high level,and is notably higher than that in secondary hospitals.Acinetobacter baumannii exhibits severe resistance to various antimicrobial agents in hospitals of different levels,and the drug resistance rate of Haemophilus in fluenzae to multiple antimicrobial agents has increased.The management of rational use of antimicrobial agents as well as prevention and control of healthcare-associated infection should continue to be strengthened,and surveillance of antimicrobial resistance should be conducted well.
作者
全国细菌耐药监测网
China Antimicrobial Resistance Surveillance System
出处
《中国感染控制杂志》
北大核心
2025年第12期1717-1734,共18页
Chinese Journal of Infection Control
关键词
抗菌药物
细菌
耐药性
监测
全国细菌耐药监测网
antimicrobial agent
bacteria
antimicrobial resistances surveillance
China Antimicrobial Resistance Surveillance System
