摘要
目的监测2015-2021年中国主要地区53所医疗机构临床分离肠杆菌属细菌分布及耐药性变迁。方法对全国53所医院在2015-2021年临床分离的肠杆菌属细菌按CHINET统一监测方案采用纸片扩散法或商品化药敏试验自动测试仪进行抗菌药物敏感性试验,依据2021年CLSI M100判读药敏结果,采用WHONET 5.6软件进行数据分析。结果2015-2021年共检出肠杆菌属细菌37966株,七年间,肠杆菌属细菌在所有临床分离菌株中的分布呈波动性变化趋势,占总体菌株的2.5%,在肠杆菌目细菌中占5.7%。肠杆菌属细菌以阴沟肠杆菌为主,为93.7%(35571/37966)。菌株主要分离自呼吸道样本,7年平均为(44.4±4.6)%,其次是分泌物/脓液样本,为(16.4±2.3)%,尿液样本为(16.0±0.9)%。在变化趋势上,阴沟肠杆菌在呼吸道样本的分布呈下降趋势,无菌体液样本的分布呈增长趋势。37966株肠杆菌属细菌主要分离自住院患者,为92.9%,门急诊患者为(7.1±0.8)%。住院患者中以外科病房患者的分离株最多,为(24.4±2.9)%。从药敏结果分析,阴沟肠杆菌对阿米卡星、替加环素、多黏菌素B、亚胺培南、美罗培南的耐药率≤7.9%;阿氏肠杆菌的耐药率则≤5.6%,但对多黏菌素B的耐药率高于阴沟肠杆菌(19.7%对3.9%);日沟维肠杆菌则对阿米卡星、替加环素、亚胺培南、美罗培南的耐药率≤8.1%,但对多黏菌素B的耐药率为10.5%。七年间,碳青霉烯类耐药的肠杆菌属细菌总体检出率为10.0%,呈逐年上升的趋势。不同科室患者分离株对不同抗菌药物的耐药率存在较大差异,成人与儿童患者分离菌株对抗菌药物的耐药率也不尽相同,碳青霉烯类耐药的阴沟肠杆菌以ICU患者样本检出率最高。结论CHINET细菌耐药监测显示2015-2021年肠杆菌属细菌的分布呈现锯齿型变化,并对多种抗菌药物耐药率增加,尤其是对碳青霉烯类的耐药率呈逐年增长的趋势。
Objective To examine the changing antimicrobial resistance profile of Enterobacter spp.isolates in 53 hospitals across China from 2015 to 2021.Methods The clinical isolates of Enterobacter spp.were collected from 53 hospitals across China during 2015-2021 and tested for antimicrobial susceptibility using Kirby-Bauer method or automated testing systems according to the CHINET unified protocol.The results were interpreted according to the breakpoints issued by the Clinical&Laboratory Standards Institute(CLSI)in 2021(M10031st edition)and analyzed with WHONET 5.6 software.Results A total of 37966 Enterobacter strains were isolated from 2015 to 2021.The proportion of Enterobacter isolates among all clinical isolates showed a fluctuating trend over the 7-year period,overall 2.5%in all clinical isolates amd 5.7%in Enterobacterale strains.The most frequently isolated Enterobacter species was Enterobacter cloacae,accounting for 93.7%(35571/37966).The strains were mainly isolated from respiratory specimens(44.4±4.6)%,followed by secretions/pus(16.4±2.3)%and urine(16.0±0.9)%.The strains from respiratory samples decreased slightly,while those from sterile body fluids increased over the 7-year period.The Enterobacter strains were mainly isolated from inpatients(92.9%),and only(7.1±0.8)%of the strains were isolated from outpatients and emergency patients.The patients in surgical wards contributed the highest number of isolates(24.4±2.9)%compared to the inpatients in any other departement.Overall,≤7.9%of the E.cloacae strains were resistant to amikacin,tigecycline,polymyxin B,imipenem or meropenem,while≤5.6%of the Enterobacter asburiae strains were resistant to these antimicrobial agents.E.asburiae showed higher resistance rate to polymyxin B than E.cloacae(19.7%vs 3.9%).Overall,≤8.1%of the Enterobacter gergoviae strains were resistant to tigecycline,amikacin,meropenem,or imipenem,while 10.5%of these strains were resistant to polycolistin B.The overall prevalence of carbapenem-resistant Enterobacter was 10.0%over the 7-year period,but showing an upward trend.The resistance profiles of Enterobacter isolates varied with the department from which they were isolated and whether the patient is an adult or a child.The prevalence of carbapenem-resistant E.cloacae was the highest in the E.cloacae isolates from ICU patients.Conclusions The results of the CHINET Antimicrobial Resistance Surveillance Program indicate that the proportion of Enterobacter strains in all clinical isolates fluctuates slightly over the 7-year period from 2015 to 2021.The Enterobacter strains showed increasing resistance to multiple antimicrobial drugs,especially carbapenems over the 7-year period.
作者
闫少珍
孙自镛
陈中举
杨洋
胡付品
朱德妹
谢轶
康梅
张峰波
季萍
胡志东
李金
郭素芳
沈瀚
周万青
徐英春
张小江
徐雪松
鄢超
王传清
付盼
贾伟
李刚
徐元宏
黄颖
郭大文
赵金英
刘文恩
李艳明
喻华
黄湘宁
单斌
杜艳
王山梅
楚亚菲
倪语星
孙景勇
俞云松
林洁
卓超
苏丹虹
魏莲花
邹凤梅
金炎
邵春红
李继红
张利侠
马娟
褚云卓
田素飞
段金菊
康建邦
汪瑞忠
房华
胡芳芳
胡云建
艾效曼
董方
吕志勇
张泓
王春
赵勇
龚萍
朱镭
孟晋华
马晓波
郑燕萍
吴劲松
卢月梅
郭如意
朱焱
温开镇
张贻荣
岳春雷
刘江山
黄文辉
薛顺虹
胡雪飞
顾洪芹
冯佼
周树平
周艳
陈运生
孟青
俞碧霞
沈继录
窦睿
王世富
贺雯
廖龙凤
姜琳
YAN Shaozhen;SUN Ziyong;CHEN Zhongju;YANG Yang;HU Fupin;ZHU Demei;XIE Yi;KANG Mei;ZHANGFengbo;JI Ping;HU Zhidong;LI Jin;GUO Sufang;SHEN Han;ZHOU Wanqing;XU Yingchun;ZHANG Xiaojiang;XU Xuesong;YAN Chao;WANG Chuanqing;FU Pan;JIA Wei;LI Gang;XU Yuanhong;HUANG Ying;GUO Dawen;ZHAO Jinying;LIU Wen’en;LI Yanming;YU Hua;HUANG Xiangning;SHAN Bin;DU Yan;WANGShanmei;CHU Yafei;NI Yuxing;SUN Jingyong;YU Yunsong;LIN Jie;ZHUO Chao;SU Danhong;WEI Lianhua;ZOU Fengmei;JIN Yan;SHAO Chunhong;LI Jihong;ZHANG Lixia;MA Juan;CHU Yunzhuo;TIAN Sufei;DUANJinju;KANG Jianbang;WANG Ruizhong;FANG Hua;HU Fangfang;HU Yunjian;AI Xiaoman;DONG Fang;LÜZhiyong;ZHANG Hong;WANG Chun;ZHAO Yong;GONG Ping;ZHU Lei;MENG Jinhua;MA Xiaobo;ZHENG Yanping;WU Jinsong;LU Yuemei;GUO Ruyi;ZHU Yan;WEN Kaizhen;ZHANG Yirong;YUE Chunlei;LIU Jiangshan;HUANG Wenhui;XUE Shunhong;HU Xuefei;GU Hongqin;FENG Jiao;ZHOU Shuping;ZHOUYan;CHEN Yunsheng;MENG Qing;YU Bixia;SHEN Jilu;DOU Rui;WANG Shifu;HE Wen;LIAO Longfeng;JIANG Lin(Department of Clinical Laboratory,Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2024年第3期309-317,共9页
Chinese Journal of Infection and Chemotherapy
基金
国家科技基础资源调查专项(2019FY101206)。
关键词
肠杆菌属
阴沟肠杆菌
细菌耐药监测
碳青霉烯类耐药
Enterobacter
Enterobacter cloacae
bacterial resistance surveillance
carbapenem-resistant
