全国细菌耐药监测网2014-2019年临床伤口及脓液标本细菌耐药监测报告
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Antimicrobial resistance of bacteria from wound and pus specimens:surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019
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    摘要:

    目的 分析全国细菌耐药监测网成员单位患者伤口、脓液标本来源细菌分布及对临床常用抗菌药物的敏感性和耐药性。方法 对全国细菌耐药监测网成员单位2014-2019年伤口及脓液标本来源细菌的药敏数据进行分析,药敏试验结果依据美国临床实验室标准化协会(CLSI)标准判读,应用WHONET 5.6软件进行药敏结果分析。结果 2014-2019年共分离伤口及脓液来源细菌1 182 888株,分离前5位的细菌依次为大肠埃希菌(27.8%)、金黄色葡萄球(21.0%)、肺炎克雷伯菌(9.0%)、铜绿假单胞菌(6.7%)、表皮葡萄球菌(3.8%)。2014-2019年耐甲氧西林金黄色萄菌(MRSA)的检出率分别为30.8%、30.0%、29.9%、29.4%、27.4%、26.9%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为75.2%、76.1%、73.0%、72.1%、71.3%、71.0%,未发现对利奈唑胺和万古霉素耐药的葡萄球菌。屎肠球菌对常见抗菌药物的耐药率高于粪肠球菌,粪肠球菌和屎肠球菌对万古霉素的耐药率分别为0.2%~0.7%和0.7%~2.0%,对利奈唑胺的耐药率为1.4%~2.3%和0.4%~1.5%,对替考拉宁的耐药率分别为0.3%~0.7%和0.9%~1.9%。肺炎链球菌对青霉素的耐药率由2015年的8.1%下降至2019年的1.4%,未发现对万古霉素和利奈唑胺耐药的肺炎链球菌。大肠埃希菌对头孢噻肟、头孢曲松的耐药率2014-2016年均为50%以上,2017-2019年略低于50%,对喹诺酮类的耐药率>38%,对复方磺胺甲口恶唑的耐药率>58%,对亚胺培南和美罗培南的敏感率最高,均>98%,其次是头孢哌酮/舒巴坦,敏感率>83%。肺炎克雷伯菌对头孢曲松、头孢噻肟、喹诺酮类和复方磺胺甲口恶唑的耐药率均低于大肠埃希菌,但对碳青霉烯类的耐药率高于大肠埃希菌,对头孢哌酮/舒巴坦的耐药率<10%。铜绿假单胞菌对头孢哌酮/舒巴坦、头孢他啶、头孢吡肟、亚胺培南、美罗培南、环丙沙星的耐药率均<15%,对阿米卡星的耐药率均<10%,鲍曼不动杆菌的总体耐药率要高于铜绿假单胞菌,对头孢吡肟、亚胺培南、美罗培南和环丙沙星的耐药率>47%,对米诺环素的耐药率<25%。结论 伤口及脓肿感染病原菌以大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌为主,对抗菌药物的耐药率较高,应定期监测伤口及脓液来源细菌的耐药性变迁,为抗菌药物合理应用和临床经验治疗提供依据。

    Abstract:

    Objective To analyze the distribution as well as antimicrobial susceptibility and resistance of bacteria isolated from wound and pus specimens from member hospitals of China Antimicrobial Resistance Surveillance System(CARSS). Methods Antimicrobial susceptibility testing data of bacteria from wound and pus specimens from member hospitals of CARSS in 2014-2019 were analyzed, antimicrobial susceptibility testing results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) and analyzed by WHONET 5.6 software. Results A total of 1 182 888 bacterial strains from wound and pus were isolated in 2014-2019, the top 5 bacteria were Escherichia coli (27.8%), Staphylococcus aureus (21.0%), Klebsiella pneumoniae (9.0%), Pseudomonas aeruginosa (6.7%), and Staphylococcus epidermidis (3.8%). In 2014-2019, isolate rates of methicillin-resistant Staphylococcus aureus (MRSA) were 30.8%, 30.0%, 29.9%, 29.4%, 27.4% and 26.9% respectively, isolate rates of methicillin-resistant coagulase negative Staphylococcus (MRCNS) were 75.2%, 76.1%, 73.0%, 72.1%, 71.3% and 71.0% respectively, linezolid- and vancomycin-resistant Staphylococcus were not found. Resistance rates of Enterococcus faecium to common antimicrobial agents were significantly higher than those of Enterococcus faecalis, resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin were 0.2%-0.7% and 0.7%-2.0% respectively, to linezolid were 1.4%-2.3% and 0.4%-1.5% respectively, and to teicoplanin were 0.3%-0.7% and 0.9%-1.9% respectively. Resistance rate of Streptococcus pneumoniae to penicillin decreased from 8.1% in 2015 to 1.4% in 2019, vancomycin- and linezolid-resistant Streptococcus pneumoniae was not found. Resistance rates of Escherichia coli to cefotaxime and ceftriaxone were both above 50% in 2014-2016, slightly lower than 50% in 2017-2019, resistance rate to quinolones was>38%, to trimethoprim-sulfamethoxazole was above 58%, and susceptibility rates to imipenem and meropenem were the highest, both were higher than 98%, followed by cefoperazone/sulbactam (>83%). Resistance rates of Klebsiella pneumoniae to ceftriaxone, cefotaxime, quinolones, and trimethoprim-sulfamethoxazole were all lower than those of Escherichia coli, but resistance rate to carbapenems was higher than that of Escherichia coli, resistance rate to cefoperazone/sulbactam was <10%. Resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam, ceftazidime, cefepime, imipenem, meropenem, and ciprofloxacin were all <15%, to amikacin were all <10%, the overall resistance rate of Acinetobacter baumannii was higher than that of Pseudomonas aeruginosa, resistance rates to cefepime, imipenem, meropenem and ciprofloxacin were all >47%, while resistance rates to minocycline was <25%. Conclusion Pathogens isolated from wound and pus are mainly Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa, antimicrobial resistance rate of bacteria is high, change of antimicrobial resistance of bacteria from wound and pus should be surveilled regularly to provide basis for rational use of antimicrobial agents and clinical treatment experience.

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全国细菌耐药监测网.全国细菌耐药监测网2014-2019年临床伤口及脓液标本细菌耐药监测报告[J]. 中国感染控制杂志,2021,20(2):145-156. DOI:10.12138/j. issn.1671-9638.20216185.
China Antimicrobial Resistance Surveillance System. Antimicrobial resistance of bacteria from wound and pus specimens:surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019[J]. Chin J Infect Control, 2021,20(2):145-156. DOI:10.12138/j. issn.1671-9638.20216185.

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  • 收稿日期:2020-11-24
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  • 在线发布日期: 2021-02-28
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