摘要
目的了解中国老年患者临床分离菌株的分布特征及耐药趋势,为老年人群感染的临床治疗提供科学依据。方法回顾性分析全国细菌耐药监测网(CARSS)2020—2024年老年患者临床分离菌株数据。按照美国临床与实验室标准化协会(CLSI)指南及食品药品监督管理局(FDA)标准判读抗菌药物敏感性(药敏)试验结果,应用WHONET 5.6软件进行统计分析。结果老年患者临床分离菌中,革兰阳性菌与阴性菌比例稳定维持在1.0∶3.5。革兰阳性菌以金黄色葡萄球菌、屎肠球菌、粪肠球菌和表皮葡萄球菌为主,2023—2024年人葡萄球菌取代溶血葡萄球菌成为第五大革兰阳性分离菌。革兰阴性菌前五位依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和嗜麦芽窄食单胞菌,2024年无乳链球菌首次进入老年患者临床分离菌株前20位(0.6%)。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)检出率略有下降,且对大部分药物耐药率均下降,但MRCNS对利奈唑胺耐药率略有升高。甲氧西林敏感金黄色葡萄球菌(MSSA)对多种药物耐药率均下降,但对左氧氟沙星耐药率从12.9%上升至14.3%。未发现对万古霉素、利奈唑胺或替考拉宁耐药的金黄色葡萄球菌。肠球菌属中,粪肠球菌对氨苄西林耐药率下降,但对利奈唑胺耐药率上升;屎肠球菌对高浓度链霉素耐药率下降,对万古霉素和替考拉宁耐药率有所上升。非脑脊液标本分离的肺炎链球菌对头孢吡肟耐药率从10.1%降至6.1%。革兰阴性菌中,大肠埃希菌对阿米卡星耐药率于2024年突升至5.0%。肺炎克雷伯菌对碳青霉烯类耐药率维持在12%,高于其它肠杆菌目细菌。耐碳青霉烯类肺炎克雷伯菌(CRKPN)对多数药物耐药率>60%。2024年铜绿假单胞菌对亚胺培南和美罗培南耐药率分别降至16.2%、13.2%,而鲍曼不动杆菌对碳青霉烯类耐药率维持在52.4%~57.9%。沙门菌属细菌对头孢曲松耐药率从2020年的15.9%逐年升至2024年的23.4%,对左氧氟沙星、复方磺胺甲口恶唑和氯霉素耐药率亦呈上升趋势。流感嗜血杆菌对氨苄西林、头孢类和阿奇霉素耐药率上升,但对左氧氟沙星非敏感率有所下降。结论2020—2024年,老年人临床分离菌的耐药性呈现一定程度波动,MRSA检出率略有下降,但耐万古霉素屎肠球菌检出率上升及CRKPN持续高耐药等问题仍然严峻,提示需持续加强老年人群的耐药监测和防控。
Objective To understand the distribution characteristics and antimicrobial resistance trends of clinically isolated bacterial strains from elderly patients in China,and provide scientific basis for the clinical treatment of infection in the elderly people.Methods Data of clinically isolated bacterial strains from elderly patients from China Antimicrobial Resistance Surveillance System(CARSS)in 2020-2024 were analyzed retrospectively.Antimicrobial susceptibility testing results were interpreted according to the guidelines of American Clinical and Laboratory Standards Institute(CLSI and the standards of American Food and Drug Administration(FDA).Statistical analysis was performed usingWHONET 5.6 software.Results Among clinical isolates of elderly patients,the ratio of Gram-positive bacteria to Gram-negative bacteria remained stable at 1.0:3.5.Gram-positive bacteria were mainly Staphylococcus aureus,Enterococcus faecium,Enterococcus faecalis,and Staphylococcus epidermidis.In 2023-2024,Staphylococcus hominis replaced Streptococcus haemolyticus as the fifth frequently isolated Gram-positive bacteria.The top five Gram-negative bacteria were Escherichia coli,Klebsiella Pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,and Stenotrophomonas maltophilia.In 2024,Streptococcus agalactiae ranked among the top 20 clinical isolates of elderly patients for the first time(0.6%).Methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant coagulase negative Staphylococcus(MRCNS)showed slightly decreased detection rates,and their resistance rates to most antimicrobial agents also decreased.However,resistance rate of MRCNS to linezolid slightly increased.The resistance rates of methicillin-sensitive Staphylococcus aureus(MSSA)to multiple agents decreased,but its resistance rate to levofloxacin increased from 12.9%to 14.3%.No Staphylococcus aureus was found to be resistant to vancomycin,linezolid,or teicoplanin.Among Enterococcusspp.,Enterococcus faecalis showed decreased resistance rate to ampicillin,but increased resistance rates to linezolid:Enterococcus faecium exhibited decreased resistance rate to high concentration streptomycin,while its resistance rates to vancomycin and teicoplanin increased.The resistance rate of Streptococcus pneumoniae isolated from non-cerebrospinal fluid specimens to cefepime decreased from 10.1%to 6.1%.Among Gram-negative bacteria,the resistance rate of Escherichia coli to amikacin has increased to 5.0%in 2024.The resistance rate of Klebsiella pneumoniae to carbapenems remained at 12%,higher than other Enterobacterales.The resistance rates of carbapenem-resistant Klebsiella pneumoniae(CRKPN)to most antimicrobial agents were>60%.In 2024,the resistance rates of Pseudomonas aeruginosa to imipenem and meropenem decreased to 16.2%and 13.2%,respectively,while the resistance rates of Acinetobacter baumannii to carbapenems remained at 52.4%-57.9%.The resistance rate of Salmonella spp.,to ceftriaxone has been increasing year by year from 15.9%in 2020 to 23.4%in 2024,and the resistance rates to levofloxacin,compound sulfamethoxazole,and chloramphenicol also presented upward trends.The resistance rates of Haemophilus in fluenzae to ampicillin,cephalosporins,and azithromycin increased,but the non-sensitivity rate to levofloxacin decreased.ConclusionFrom 2020 to 2024,antimicrobial resistance of clinically isolated bacteria from the elderly people showed a certain degree of fluctuation,with a slight decreased in the detection rate in MRSA.However,problems such as the increased detection rate of vancomycin-resistant Enterococcus faecium and the persistent high resistance of CRKPN still remain serious,indicating that persistent antimicrobial resistance surveillance and prevention in the elderly people should be strengthened.
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1746-1760,共15页
Chinese Journal of Infection Control
关键词
老年人
细菌
耐药监测
MRSA
VRE
CRKPN
全国细菌耐药监测网
elderly people
bacteria
antimicrobial resistance surveillance
MRSA
VRE
CRKPN
China Anti-microbial Resistance Surveillance System
