2014年CHINET中国细菌耐药性监测
2014년CHINET중국세균내약성감측
CHINET 2014 surveillance of bacterial resistance in China
  • 万方数据
    中国感染与化疗杂志 중국감염여화료잡지
    Chinese Journal of Infection and Chemotherapy
    2015年 5期 401-410 ,共10页

    胡付品%朱德妹%汪复%蒋晓飞%徐英春%张小江%张朝霞%季萍%谢轶%康梅%王传清%王爱敏%徐元宏%沈继录%孙自镛%陈中举%倪语星%孙景勇%褚云卓%田素飞%胡志东%李金%俞云松%林洁%单斌%杜艳%韩艳秋%郭素芳%魏莲花%吴玲%张泓%孔菁%胡云建%艾效曼%卓超%苏丹虹

    호부품%주덕매%왕복%장효비%서영춘%장소강%장조하%계평%사질%강매%왕전청%왕애민%서원굉%침계록%손자용%진중거%예어성%손경용%저운탁%전소비%호지동%리금%유운송%림길%단빈%두염%한염추%곽소방%위연화%오령%장홍%공정%호운건%애효만%탁초%소단홍

    细菌耐药性监测%药物敏感性试验%多重耐药菌%广泛耐药菌%万古霉素耐药肠球菌%耐甲氧西林葡萄球菌%耐青霉素肺炎链球菌%碳青霉烯酶 細菌耐藥性鑑測%藥物敏感性試驗%多重耐藥菌%廣汎耐藥菌%萬古黴素耐藥腸毬菌%耐甲氧西林葡萄毬菌%耐青黴素肺炎鏈毬菌%碳青黴烯酶
    세균내약성감측%약물민감성시험%다중내약균%엄범내약균%만고매소내약장구균%내갑양서림포도구균%내청매소폐염련구균%탄청매희매
    目的：了解国内主要地区临床分离菌对常用抗菌药物的敏感性和耐药性。方法国内主要地区17所教学医院（15所综合性医院、2所儿童医院）临床分离菌采用纸片扩散法或自动化仪器法按统一方案进行细菌药物敏感性试验。按美国临床和实验室标准化协会（CLSI）2014版标准判断结果。结果收集各医院2014年1—12月临床分离菌共78955株，其中革兰阳性菌21635株，占27．4％，革兰阴性菌57320株，占72．6％。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株的平均检出率分别为44．6％和83．0％。甲氧西林耐药株（MRSA和MRCNS）对β内酰胺类抗生素和其他测试药的耐药率均显著高于甲氧西林敏感株（MSSA和MSCNS）。MRSA中有92．0％菌株对甲氧苄啶‐磺胺甲口恶唑敏感；MRCNS中有85．6％的菌株对利福平敏感。未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物（氯霉素除外）的耐药率显著低于屎肠球菌，两者中均有少数万古霉素耐药株，表型或基因型检测结果显示主要为V anA 型、其次为V anB型或V anM型耐药。肺炎链球菌非脑膜炎株成人株和儿童株中青霉素敏感株（PSSP）所占比例较2013年均有所上升，中介（PISP）和耐药（PRSP）的检出率均有所下降。大肠埃希菌、克雷伯菌属（肺炎克雷伯菌和产酸克雷伯菌）和奇异变形杆菌中产超广谱β内酰胺酶（ESBL ）株平均分别为55．8％、29．9％和24．0％，产ESBL株对测试药物的耐药率均比非产 ESBL株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感，绝大多数菌株的耐药率低于10％。不动杆菌属（鲍曼不动杆菌占93．0％）对亚胺培南和美罗培南的耐药率分别为62．4％和66．7％。与2013年相比，肺炎克雷伯菌和鲍曼不动杆菌中广泛耐药株的检出率有所上升。结论细菌耐药性仍呈增长趋势，多重耐药和广泛耐药菌株检出率的增加对临床抗感染治疗构成严重威胁，需及时采取有效的感控措施。
    목적：료해국내주요지구림상분리균대상용항균약물적민감성화내약성。방법국내주요지구17소교학의원（15소종합성의원、2소인동의원）림상분리균채용지편확산법혹자동화의기법안통일방안진행세균약물민감성시험。안미국림상화실험실표준화협회（CLSI）2014판표준판단결과。결과수집각의원2014년1—12월림상분리균공78955주，기중혁란양성균21635주，점27．4％，혁란음성균57320주，점72．6％。금황색포도구균화응고매음성포도구균중갑양서림내약주적평균검출솔분별위44．6％화83．0％。갑양서림내약주（MRSA화MRCNS）대β내선알류항생소화기타측시약적내약솔균현저고우갑양서림민감주（MSSA화MSCNS）。MRSA중유92．0％균주대갑양변정‐광알갑구악서민감；MRCNS중유85．6％적균주대리복평민감。미발현만고매소、체고랍저화리내서알내약주。장구균속중분장구균대다수측시항균약물（록매소제외）적내약솔현저저우시장구균，량자중균유소수만고매소내약주，표형혹기인형검측결과현시주요위V anA 형、기차위V anB형혹V anM형내약。폐염련구균비뇌막염주성인주화인동주중청매소민감주（PSSP）소점비례교2013년균유소상승，중개（PISP）화내약（PRSP）적검출솔균유소하강。대장애희균、극뢰백균속（폐염극뢰백균화산산극뢰백균）화기이변형간균중산초엄보β내선알매（ESBL ）주평균분별위55．8％、29．9％화24．0％，산ESBL주대측시약물적내약솔균비비산 ESBL주고。장간균과세균대탄청매희류항생소잉고도민감，절대다수균주적내약솔저우10％。불동간균속（포만불동간균점93．0％）대아알배남화미라배남적내약솔분별위62．4％화66．7％。여2013년상비，폐염극뢰백균화포만불동간균중엄범내약주적검출솔유소상승。결론세균내약성잉정증장추세，다중내약화엄범내약균주검출솔적증가대림상항감염치료구성엄중위협，수급시채취유효적감공조시。
    Objective To investigate the susceptibility and resistance of clinical isolates from hospitals in several regions of China .Methods Fifteen general hospitals and two children′s hospitals were involved in this program . Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby‐Bauer method or automated systems .Results were analyzed according to CLSI 2014 breakpoints .Results A total of 78 955 clinical isolates were collected from January to December 2014 ,of which gram negative organisms and gram positive cocci accounted for 72 .6% and 27 .4% ,respectively . Methicillin‐resistant strains in S .aureus(MRSA)and coagulase negative Staphylococcus(MRCNS)accounted for an average of 44 .6% and 83 .0 % ,respectively .The resistance rates of methicillin‐resistant strains to β‐lactams and other antimicrobial agents were much higher than those of methicillin‐susceptible strains .However ,92 .0% of MRSA strains were still susceptible to trimethoprim‐sulfamethoxazole ,while 85 .6% of MRCNS strains were susceptible to rifampin .No staphylococcal strains were found resistant to vancomycin ,teicoplanin or linezolid .In Enterococcus spp .,the resistance rates of E .f aecalis strains to most tested drugs (except chloramphenicol) were much lower than those of E . f aecium .Some strains of both species were resistant to vancomycin .Vancomycin resistant strains of E . f aecalis and E . f aecium were mainly V anA ,V anB or V anM type based on their phenotype or genotype .Regarding non‐meningitis S .pneumoniae strains ,the prevalence of penicillin‐susceptible S .pneumoniae strains isolated from both adults and children were higher than those isolated in 2013 ,but the prevalence of penicillin‐intermediate S . pneumoniae or penicillin‐resistant S . pneumoniae strains decreased . The prevalence of ESBLs producingstrainswas55.8% in E.coliand29.9% in Klebsiellaspp.(K.pneumoniaeand K.oxytoca)and24.0% in Proteus mirabilis isolates on average . ESBLs‐producing Enterobacteriaceae strains were more resistant than non‐ESBLs‐producing strains in terms of antibiotic resistance rates . The strains of Enterobacteriaceae were still highly susceptible to carbapenems .Overall less than 10 % of these strains were resistant to carbapenems . About 62 .4% and 66 .7% of Acinetobacter spp .(A .baumannii accounts for 93 .0 % ) strains were resistant to imipenem and meropenem ,respectively . Compared with the data of year 2013 ,extensively‐drug resistant strains in K . pneumoniae and A .baumannii increased . Conclusions The antibiotic resistance of clinical bacterial isolates is growing .The disseminated multi‐drug or pan‐drug resistant strains in a special region poses a serious threat to clinical practice and implies the importance of strengthening infection control .
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