2012年中国CHINET血培养临床分离菌的分布及耐药性
2012년중국CHINET혈배양림상분리균적분포급내약성
The distribution and antibiotic resistance of clinical isolates from blood culture in 2012 CHINET surveillance program in China
  • 万方数据
    中国感染与化疗杂志 중국감염여화료잡지
    CHINESE JOURNAL OF INFECTION AND CHEMOTHERAPY
    2014年 6期 474-481 ,共8页

    李光辉%朱德妹%汪复%胡志东%李全%孙自镛%陈中举%徐英春%张小江%王传清%王爱敏%倪语星%孙景勇%褚云卓%俞云松%林洁%徐元宏%沈继录%苏丹虹%卓超%魏莲花%吴玲%张朝霞%季萍%张泓%孔菁%胡云建%艾效曼%单斌%杜艳

    리광휘%주덕매%왕복%호지동%리전%손자용%진중거%서영춘%장소강%왕전청%왕애민%예어성%손경용%저운탁%유운송%림길%서원굉%침계록%소단홍%탁초%위연화%오령%장조하%계평%장홍%공정%호운건%애효만%단빈%두염

    血培养%临床分离菌%敏感性 血培養%臨床分離菌%敏感性
    혈배양%림상분리균%민감성
    blood culture%clinical isolate%antimicrobial susceptibility
    目的了解2012年中国CHINET血培养分离菌的构成及耐药性。方法对中国CHINET 细菌耐药监测网2012年1月至12月所有血培养分离菌，按统一方案用K‐B纸片扩散法进行抗菌药物敏感试验。结果2012年自血标本中共获分离菌8490株，其中革兰阳性球菌占56．0％，革兰阴性杆菌占44．0％。居前10位的分离菌依次为凝固酶阴性葡萄球菌（CNS ）（35．5％）、大肠埃希菌（16．4％）、克雷伯菌属（9．8％）（其中91．1％为肺炎克雷伯菌）、肠球菌属（7．2％）、金黄色葡萄球菌（金葡菌）（7．2％）、不动杆菌属（5．9％）（其中93．8％为鲍曼不动杆菌）、草绿色链球菌（4．3％）、铜绿假单胞菌（3．2％）、肠杆菌属（2．4％）和洋葱伯克霍尔德菌（1．5％） ，占所有分离菌株的93．5％。甲氧西林耐药金葡菌（M RSA ）、甲氧西林耐药 CNS （MRCNS）分别占金葡菌和CNS的50．8％和61．7％。粪肠球菌对高浓度庆大霉素和氨苄西林的耐药率分别为29．0％和10． 9％，屎肠球菌对多数测试药物的耐药率显著高于粪肠球菌。草绿色链球菌对青霉素的耐药率为3．8％。儿童分离株中青霉素耐药肺炎链球菌株为31．2％，与成人分离株大致相仿（34．1％）。葡萄球菌属、肺炎链球菌、其他链球菌属和粪肠球菌中均未发现万古霉素和利奈唑胺耐药菌株，屎肠球菌对万古霉素的耐药率为3．5％。大肠埃希菌、肠杆菌属、沙雷菌属、变形菌属和枸橼酸菌属等肠杆菌科细菌对碳青霉烯类的耐药率均在10．0％以下，唯克雷伯菌属对碳青霉烯类耐药率为11．2％～19．8％。不发酵糖革兰阴性杆菌对碳青霉烯类耐药率较高，铜绿假单胞菌对碳青霉烯类的耐药率近30．0％，对不动杆菌属耐药率达70．0％以上。结论2012年中国CHINET监测资料显示，血培养分离菌仍以革兰阳性菌为主，但检出比例有所下降，革兰阴性菌有所上升。血培养分离株对常用抗菌药物耐药性仍严重，尤其革兰阴性菌对碳青霉烯类耐药率呈上升趋势。因此应合理应用抗菌药物，并加强医院感染控制措施抑制耐药菌传播。
    목적료해2012년중국CHINET혈배양분리균적구성급내약성。방법대중국CHINET 세균내약감측망2012년1월지12월소유혈배양분리균，안통일방안용K‐B지편확산법진행항균약물민감시험。결과2012년자혈표본중공획분리균8490주，기중혁란양성구균점56．0％，혁란음성간균점44．0％。거전10위적분리균의차위응고매음성포도구균（CNS ）（35．5％）、대장애희균（16．4％）、극뢰백균속（9．8％）（기중91．1％위폐염극뢰백균）、장구균속（7．2％）、금황색포도구균（금포균）（7．2％）、불동간균속（5．9％）（기중93．8％위포만불동간균）、초록색련구균（4．3％）、동록가단포균（3．2％）、장간균속（2．4％）화양총백극곽이덕균（1．5％） ，점소유분리균주적93．5％。갑양서림내약금포균（M RSA ）、갑양서림내약 CNS （MRCNS）분별점금포균화CNS적50．8％화61．7％。분장구균대고농도경대매소화안변서림적내약솔분별위29．0％화10． 9％，시장구균대다수측시약물적내약솔현저고우분장구균。초록색련구균대청매소적내약솔위3．8％。인동분리주중청매소내약폐염련구균주위31．2％，여성인분리주대치상방（34．1％）。포도구균속、폐염련구균、기타련구균속화분장구균중균미발현만고매소화리내서알내약균주，시장구균대만고매소적내약솔위3．5％。대장애희균、장간균속、사뢰균속、변형균속화구연산균속등장간균과세균대탄청매희류적내약솔균재10．0％이하，유극뢰백균속대탄청매희류내약솔위11．2％～19．8％。불발효당혁란음성간균대탄청매희류내약솔교고，동록가단포균대탄청매희류적내약솔근30．0％，대불동간균속내약솔체70．0％이상。결론2012년중국CHINET감측자료현시，혈배양분리균잉이혁란양성균위주，단검출비례유소하강，혁란음성균유소상승。혈배양분리주대상용항균약물내약성잉엄중，우기혁란음성균대탄청매희류내약솔정상승추세。인차응합리응용항균약물，병가강의원감염공제조시억제내약균전파。
    Objective To investigate the distribution and antibiotic resistance of clinical isolates from blood culture in 15 hospitals across China in 2012 .Methods The susceptibilities of blood culture isolates to more than 20 antimicrobial agents were determined by Kirby‐Bauer method according to a unified protocol .Results A total of 8 490 strains were isolated from blood samples in 2012 ,of which gram positive cocci and gram negative bacilli accounted for 56 .0% and 44 .0% respectively .The top ten isolates were coagulase negative Staphylococcus (CNS ) (35 .5% ) , E . coli (16 .4% ) , K lebsiella spp . (9 .8% ) , Enterococcus spp .(7 .2% ) ,S .aureus (7 .2% ) ,Acinetobacter spp .(5 .9% ) ,S .viridans (4 .3% ) ,P .aeruginosa (3 .2% ) , Entrobacter spp .(2 .4% ) and Burkholderia spp .(1 .5% ) ,together accounting for 93 .5% of all the blood culture isolates . The prevalence of MRSA among S .aureus and MRCNS among CNS was 50 .8% and 61 .7% ,respectively .About 29 .0% and 10 .9% of the E . f aecalis isolates were resistant to high level gentamicin and ampicillin respectively ,significantly lower than thatofE.faecium.Penicillinresistancewasfoundin3.8% oftheS.viridansstrainsand31.2% oftheS.pneumoniae strains isolated from adults , and 34 .1% of the S . pneumoniae strains isolated from children . Vancomycin‐resistant Enterococcus was identified in 3 .5% of the E . f aecium isolates .No strains were found resistant to vancomycin or linezolid in Staphylococcus spp .,Streptococcus spp .,S .pneumoniae and E .faecalis .About 11 .2% to 19 .8% of the Klebsiella strains were resistant to carbapenems .For the other Enterobacteriaceae species ,less than 10 .0% of the isolates were resistant to carbapenems .Nonfermenters were highly resistant to carbapenems ,especially Acinetobacter spp .(71 .6% resistant) and P .aeruginosa (nearly 30 .0% resistant) .Conclusions Gram positive cocci still play an important role in blood stream infections in 2012 CHINET program ,but the proportion decreases compared to previous years .Resistance to the fist line antibiotics is common among the blood isolates ,especially the increase of carbapenem resistance in gram negative bacteria .Antimicrobial agents should be used appropriately to reduce the selection pressure . Hospital infection control measures should be strengthened to prevent the spread of resistant organisms .
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