中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
22期
1739-1746
,共8页
赵春江%陈宏斌%王辉%刘文恩%卓超%褚云卓%曾吉%金炎%胡志东
趙春江%陳宏斌%王輝%劉文恩%卓超%褚雲卓%曾吉%金炎%鬍誌東
조춘강%진굉빈%왕휘%류문은%탁초%저운탁%증길%금염%호지동
血流感染%院内获得性肺炎%腹腔感染%耐药监测%甲氧西林耐药的金黄色葡萄球菌%超广谱β内酰胺酶
血流感染%院內穫得性肺炎%腹腔感染%耐藥鑑測%甲氧西林耐藥的金黃色葡萄毬菌%超廣譜β內酰胺酶
혈류감염%원내획득성폐염%복강감염%내약감측%갑양서림내약적금황색포도구균%초엄보β내선알매
Bloodstream infections%Hospital-acquired pneumonia%Intra-abdominal infections%Resistance surveillance%Methicillin-resistant Staphylococcus aureus%Extended spectrum β-lactamase
目的 明确2013年在我国引起院内感染的主要病原菌的病原谱及对抗菌药物的敏感性.方法 收集来自全国13家教学医院的引起院内血流感染(BSI)、院内获得性肺炎(HAP)和院内获得性腹腔感染(IAI)的病原菌,使用琼脂稀释法测定菌株的最低抑菌浓度(MIC),判定标准使用美国临床和实验室标准协会(CLSI) M100-S23的规定.结果 共收集BSI病例1 022例、HAP病例683例和IAI病例674例.大肠埃希菌和肺炎克雷伯菌是引起BSI和IAI的最主要的致病菌,而鲍曼不动杆菌和铜绿假单胞菌是引起HAP的最主要致病菌.替加环素、亚胺培南和美罗培南对肠杆菌科细菌表现出很高的抗菌活性,敏感率分别为95.6％、94.2％和95.2％.肠杆菌科细菌对头孢菌素和氟喹诺酮类耐药率较高,分别为52.3％和38.9％,但对β-内酰胺类联合酶抑制剂敏感性较高.在肠杆菌细菌中超广谱β内酰胺酶(ESBLs)的发生率为30.5％,碳青霉烯耐药的肠杆菌科细菌(CRE)的发生率为4.3％.鲍曼不动杆菌除对替加环素(90.5％)和多粘菌素(100％)表现出较高的敏感性,对其他抗菌药物均表现出较高的耐药率.有76.6％的鲍曼不动杆菌对碳青霉烯耐药.阿米卡星、环丙沙星、头孢吡肟和哌拉西林/他唑巴坦对铜绿假单胞菌的抗菌效果较好,敏感率分别为88.5％、77.6％、72.7％和64.5％.铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为42.1％和32.2％.166株金黄色葡萄球菌对替加环素、利奈唑胺、达托霉素和糖肽类抗生素都表现为敏感.甲氧西林耐药的金黄色葡萄球菌(MRSA)在金黄色葡萄球菌中的比例为46.9％.MRSA在IAI中占金黄色葡萄球菌的比例为55.2％,在HAP中为54.4％,均高于其在BSI中的比例(35.0％).未发现对替加环素、利奈唑胺和达托霉素耐药的肠球菌.万古霉素耐药的肠球菌(VRE)只在屎肠球菌中发现,占屎肠球菌的1.9％.结论 大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌是院内感染的最常见病原菌.替加环素对于引起院内感染的致病菌有较强的抗菌活性.对产ESBLs的肠杆菌科细菌对β内酰胺联合酶抑制剂和碳青霉烯类药物的敏感性高.万古霉素、替考拉宁和利奈唑胺对葡萄球菌和肠球菌作用效果好.
目的 明確2013年在我國引起院內感染的主要病原菌的病原譜及對抗菌藥物的敏感性.方法 收集來自全國13傢教學醫院的引起院內血流感染(BSI)、院內穫得性肺炎(HAP)和院內穫得性腹腔感染(IAI)的病原菌,使用瓊脂稀釋法測定菌株的最低抑菌濃度(MIC),判定標準使用美國臨床和實驗室標準協會(CLSI) M100-S23的規定.結果 共收集BSI病例1 022例、HAP病例683例和IAI病例674例.大腸埃希菌和肺炎剋雷伯菌是引起BSI和IAI的最主要的緻病菌,而鮑曼不動桿菌和銅綠假單胞菌是引起HAP的最主要緻病菌.替加環素、亞胺培南和美囉培南對腸桿菌科細菌錶現齣很高的抗菌活性,敏感率分彆為95.6％、94.2％和95.2％.腸桿菌科細菌對頭孢菌素和氟喹諾酮類耐藥率較高,分彆為52.3％和38.9％,但對β-內酰胺類聯閤酶抑製劑敏感性較高.在腸桿菌細菌中超廣譜β內酰胺酶(ESBLs)的髮生率為30.5％,碳青黴烯耐藥的腸桿菌科細菌(CRE)的髮生率為4.3％.鮑曼不動桿菌除對替加環素(90.5％)和多粘菌素(100％)錶現齣較高的敏感性,對其他抗菌藥物均錶現齣較高的耐藥率.有76.6％的鮑曼不動桿菌對碳青黴烯耐藥.阿米卡星、環丙沙星、頭孢吡肟和哌拉西林/他唑巴坦對銅綠假單胞菌的抗菌效果較好,敏感率分彆為88.5％、77.6％、72.7％和64.5％.銅綠假單胞菌對亞胺培南和美囉培南的耐藥率分彆為42.1％和32.2％.166株金黃色葡萄毬菌對替加環素、利奈唑胺、達託黴素和糖肽類抗生素都錶現為敏感.甲氧西林耐藥的金黃色葡萄毬菌(MRSA)在金黃色葡萄毬菌中的比例為46.9％.MRSA在IAI中佔金黃色葡萄毬菌的比例為55.2％,在HAP中為54.4％,均高于其在BSI中的比例(35.0％).未髮現對替加環素、利奈唑胺和達託黴素耐藥的腸毬菌.萬古黴素耐藥的腸毬菌(VRE)隻在屎腸毬菌中髮現,佔屎腸毬菌的1.9％.結論 大腸埃希菌、肺炎剋雷伯菌、鮑曼不動桿菌和銅綠假單胞菌是院內感染的最常見病原菌.替加環素對于引起院內感染的緻病菌有較彊的抗菌活性.對產ESBLs的腸桿菌科細菌對β內酰胺聯閤酶抑製劑和碳青黴烯類藥物的敏感性高.萬古黴素、替攷拉寧和利奈唑胺對葡萄毬菌和腸毬菌作用效果好.
목적 명학2013년재아국인기원내감염적주요병원균적병원보급대항균약물적민감성.방법 수집래자전국13가교학의원적인기원내혈류감염(BSI)、원내획득성폐염(HAP)화원내획득성복강감염(IAI)적병원균,사용경지희석법측정균주적최저억균농도(MIC),판정표준사용미국림상화실험실표준협회(CLSI) M100-S23적규정.결과 공수집BSI병례1 022례、HAP병례683례화IAI병례674례.대장애희균화폐염극뢰백균시인기BSI화IAI적최주요적치병균,이포만불동간균화동록가단포균시인기HAP적최주요치병균.체가배소、아알배남화미라배남대장간균과세균표현출흔고적항균활성,민감솔분별위95.6％、94.2％화95.2％.장간균과세균대두포균소화불규낙동류내약솔교고,분별위52.3％화38.9％,단대β-내선알류연합매억제제민감성교고.재장간균세균중초엄보β내선알매(ESBLs)적발생솔위30.5％,탄청매희내약적장간균과세균(CRE)적발생솔위4.3％.포만불동간균제대체가배소(90.5％)화다점균소(100％)표현출교고적민감성,대기타항균약물균표현출교고적내약솔.유76.6％적포만불동간균대탄청매희내약.아미잡성、배병사성、두포필우화고랍서림/타서파탄대동록가단포균적항균효과교호,민감솔분별위88.5％、77.6％、72.7％화64.5％.동록가단포균대아알배남화미라배남적내약솔분별위42.1％화32.2％.166주금황색포도구균대체가배소、리내서알、체탁매소화당태류항생소도표현위민감.갑양서림내약적금황색포도구균(MRSA)재금황색포도구균중적비례위46.9％.MRSA재IAI중점금황색포도구균적비례위55.2％,재HAP중위54.4％,균고우기재BSI중적비례(35.0％).미발현대체가배소、리내서알화체탁매소내약적장구균.만고매소내약적장구균(VRE)지재시장구균중발현,점시장구균적1.9％.결론 대장애희균、폐염극뢰백균、포만불동간균화동록가단포균시원내감염적최상견병원균.체가배소대우인기원내감염적치병균유교강적항균활성.대산ESBLs적장간균과세균대β내선알연합매억제제화탄청매희류약물적민감성고.만고매소、체고랍저화리내서알대포도구균화장구균작용효과호.
Objective To investigate the spectrum and antimicrobial resistance of major pathogensthat causing nosocomial infections in China,2013.Methods Nosocomial cases as well as pathogens causing bloodstream infections (BSI),hospital-acquired pneumonia (HAP) and intra-abdominal infections (IAI) from 13 teaching hospital around China were collected.The minimum inhibitory concentrations (MICs) were determined by the agar dilution method.The CLSI M100-S23 criteria were used for interpretation.Results Of all cases,1 022 cases were from BSI,683 from HAP and 674 from IAI.Escherichia coli and Klebsiella pneumoniae were the most prevalent pathogens causing BSI and IAI while Acinetobacter baumanii (34.6％) and Pseudomonas aeruginosa were dominated in HAP.Tigecycline,imipenem and meropenem exhibited high potency against Enterobacteriaceae and the susceptibilities rates were 95.6％,94.2％ and 95.2％ respectively.Enterobacteriaceae demonstrated high resistance against cephalosporins (52.3％) and fluoroquinolones (38.9％) but were susceptible to β-lactam + inhibitor.Of all the Enterobacteriaceae,30.5％ were ESBLs positive and 4.3％ were carbapenem resistant.Acinetobacter baumanii showed low susceptibilities to the microbial agents except for tigecycline (90.5％) and colistin (100％).The rate of carbapenem resistant Acinetobacter baumanii was 76.6％.Amikacin,ciprofloxacin,cefepime and piperacillin/tazobactam showed high antibacterial activity against Pseudomonas aeruginosa with susceptible rate 88.5％,77.6％,72.7％ and 64.5％ respectively.The resistant rate to imipenem and meropenem were 42.1％ and 32.2％.All Staphylococcus aureus (166 strains) were susceptible to tigecycline,linezolid,daptomycin and glycopeptides.MRSA accounted for 46.9％ of all the Staphylococcus aureus.The prevalence of MRSA in IAI (55.2％) and HAP (54.4％) were higher that that in BSI (35.0％).No Enterococcus strains were found resistant to tigecycline,linezolid and daptomycin.VRE was found in Enterococcus faecium,accounting for 1.9％ of all Enterococcus faecium strains.Conclusions Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa are the most common pathogens causing nosocomial infections.Nosocomial pathogens showed high susceptibilities against tigecycline.For ESBLs-producing Enterobacteriaceae strains,β-lactam + Inhibitor show high antibacterial activities.Vancomycin,teicoplanin and linezolid exhibit high potency to Staphylococcus aureus and Enterococcus.
