摘要
目的总结2005-2014年CHINET呼吸道分离菌的分布及耐药性。方法CHINET成员单位按统一方案、采用统一的材料,药敏试验采用纸片扩散法(K-B法)、自动化仪器法及E试验法,按照美国CLSI 2014年版标准判读结果,用WHONET 5.6软件统计分析呼吸道标本分离菌的分布及耐药性。结果2005-2014年呼吸道标本共分离出229 170株细菌,其中革兰阴性菌占78.8%,革兰阳性菌占18.4%。常见细菌依次为鲍曼不动杆菌(16.7%)、铜绿假单胞菌(16.5%)、肺炎克雷伯菌(14.8%)、金黄色葡萄球菌(金葡菌)(11.8%)、大肠埃希菌(7.1%)、嗜麦芽窄食单胞菌(5.8%)、阴沟肠杆菌(3.8%)、肺炎链球菌(3.7%)、流感嗜血杆菌(3.1%)等。药敏结果显示,儿童患者中肺炎链球菌青霉素耐药和中介菌株(PRSP、PISP)检出率分别为16.1%、23.5%,明显高于成人患者(3.3%、5.9%),儿童患者中PRSP发生率明显增加,从2006年5.4%上升至2013年21.9%;β溶血链球菌对青霉素和头孢菌素类高度敏感,肺炎链球菌和A群链球菌对红霉素、克林霉素耐药率>80%,对氟喹诺酮类、万古霉素、利奈唑胺仍保持较高敏感率。流感嗜血杆菌成人株与儿童株中β内酰胺酶检出率分别为22.7%与36.5%,对阿奇霉素、头孢呋辛、左氧氟沙星敏感率>90%。金葡菌中未检出万古霉素、替考拉宁、利奈唑胺耐药株,甲氧西林耐药金葡菌(MRSA)检出率为60.8%。大肠埃希菌对碳青霉烯类最敏感(耐药率<3%),其次为头孢哌酮-舒巴坦、哌拉西林-他唑巴坦(耐药率<10%)。肺炎克雷伯菌对亚胺培南、美罗培南耐药率逐年增高,分别从2005年3.1%、2.5%上升至2014年10.3%、14.2%,亚胺培南耐药肺炎克雷伯菌仅对替加环素耐药率较低为12.8%。鲍曼不动杆菌对米诺环素、头孢哌酮-舒巴坦、亚胺培南、美罗培南耐药率逐年增加,对替加环素耐药率较低为6.7%。铜绿假单胞菌对主要抗菌药物耐药率逐年降低,对阿米卡星、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、头孢吡肟、头孢他啶、环丙沙星、庆大霉素耐药率<30%。结论呼吸道病原菌仍以革兰阴性杆菌为主,细菌耐药现象严重,临床应重视病原菌的监测并结合药敏试验结果合理使用抗菌药物。
Objective To investigate the distribution and antimicrobial resistance profile of the common respiratory pathogens isolated from hospitals across China from 2005 to 2014. Methods Antimicrobial susceptibility testing was carried out by means of Kirby-Bauer method, automatic microbiological analysis systems and E-test according to the unified protocol. The data were analyzed by WHONET 5.6 software in terms of CLSI breakpoints （2014）. Results A total of 229 170 nonduplicate bacterial strains were isolated from respiratory secretion from 2005 to 2014, of which gram negative bacilli accounted for 78.8 %, and gram- positive cocci 18.4 %. The most common species were A. baumannii （16.7 %）, P. aeruginosa （16.5 %）, K. pneumoniae （14.8 %）, S. aureus （11.8 %）, E. coli （7.1%）, S. maltophilia （5.8 %）, E. cloacae （3.8 %）, S. pneumoniae （3.7 %）, and H. influenzae （3.1%）. The prevalence of penicillin non-susceptible strains PISP and PRSP were 16.1% and 23.5 %, respectively in the S. pneumoniae isolates from children, which were higher than those from adults （3.3 %, 5.9 %）. The prevalence of PRSP increased significantly in children from 5.4 % in 2006 to 21.9 % in 2013. The p-hemolytic Streptococcus strains were highly sensitive to penicillins and cephalosporins. More than 80 % of the S. pneumoniae and Group A Streptococcus isolates were resistant to erythromycin and clindamycin, but these strains were highly sensitive to ftuoroquinolones, vancomycin and linezolid. The prevalence of β-lactamase-producing H. influenzae strains was 22.7 % in adults and 36.5 % in children, respectively. More than 90 % of the H. influenzae isolates were still susceptible to azithromycin, cefuroxime and levofloxacin. Methicillin resistant strains accounted for 60.8 % in S. aureus. No staphylococcal strain was found resistant to vancomycin, teicoplanin or linezolid. Carbapenems were still the most active agents against E, coli （〈 3 % resistant）. Lower than 10 % of the E. coli strains were resistant to cefoperazone-sulbactam and piperacillin-tazobactam. More K. pneumoniae strains were found resistant to imipenem and meropenem over time, from 3.1% and 2.5 % in 2005 to 10.3 % and 14.2 % in 2014. Tigecycline was the most active agent against imipenem-resistant K. pneumoniae （12.8 % resistant）. More A. baumannii strains were resistant to minocycline, cefoperazone-sulbactam, imipenem and meropenem over years, while tigecycline （6.7 % resistant） was the most active agent. P. aeruginosa strains showed decreasing resistance to most antibiotics during the period from 2005 to 2014. Lower than 30 % of P. aeruginosa strains were resistant to amikacin, piperacillin-tazobactam, cefoperazone- sulbactam, cefepime, ceftazidime, ciprofloxacin and gentamicin. Conclusions Gram-negative bacilli were still the most common pathogens in respiratory tract infections associated with serious antibiotic resistance. More attention should be paid to the monitoring of pathogens, and rational use of antimicrobial agents according to the results of antimicrobial susceptibility testing.
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2016年第5期541-550,共10页
Chinese Journal of Infection and Chemotherapy
关键词
呼吸道感染
病原菌
耐药性监测
respiratory tract infection
pathogen
antimicrobial resistance surveillance
