【摘要】 目的了解国内主要地区临床分离菌对临床常用抗菌药物的敏感性和耐药性。方法对国内主要地区34所医院(29所综合性医院、5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抗菌药物敏感性试验。按CLSI 2017版判断结果。结果收集2017年1-12月上述医院临床分离菌共190 610株,其中革兰阳性菌55 649株,占29.2%,革兰阴性菌134 951株,占70.8%。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(MRSA和MRCNS)的平均检出率分别为35.3%和80.3%。MRSA和MRCNS对绝大多数测试药物的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS)。MRSA中有91.6%菌株对甲氧苄啶-磺胺甲唑敏感;MRCNS中有86.2%的菌株对利福平敏感。未发现万古霉素耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物(除外氯霉素)的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株,根据对50株万古霉素耐药肠球菌的表型推测或基因型检测结果,显示主要为van A型(36株)、van B型(8株)或van M型(6株)耐药。肺炎链球菌非脑膜炎株儿童株中青霉素敏感株(86.8%)和耐药株(2.2%)所占比例较2016年有所下降,中介株的检出率(11.0%)有所上升。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于10.0%(除外克雷伯菌属)。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别从2005年的3.0%和2.9%上升到了2017年的20.9%和24.0%,耐药率上升幅度高达8倍,与此同时,肺炎克雷伯菌每年的分离率亦呈稳步上升趋势。不动杆菌属(鲍曼不动杆菌占91.5%)对亚胺培南和美罗培南的耐药率分别为66.7%和69.3%。与2016年耐药性数据相比,铜绿假单胞菌对碳青霉烯类抗菌药物的耐药率(23.6%对20.9%)继续呈下降趋势。结论临床分离菌对常见抗菌药物的耐药率仍呈增长趋势,尤其是碳青霉烯类耐药肺炎克雷伯菌,应加强医院感染防控措施和抗菌药物临床应用管理措施,在继续做好细菌耐药监测工作的同时加强实验室与临床的沟通,以发挥耐药监测工作的最大价值。更多还原

【Abstract】 Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China.Methods Twenty-nine general hospitals and five 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 interpreted according to CLSI 2017 breakpoints.Results A total of 190 610 clinical isolates were collected from January to December 2017,of which gram negative organisms accounted for 70.8%(134 951/190 610) and gram positive cocci 29.2%(55 649/190 610).The prevalence of methicillin-resistant strains was 35.3% in S.aureus(MRSA) and 80.3% in coagulase negative Staphylococcus(MRCNS) on average.MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains.However,91.6% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 86.2% of MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin.E.faecalis strains showed much lower resistance rates to most of the drugs tested(except chloramphenicol) than E.faecium.Vancomycin-resistant Enterococcus(VRE) was identified in both E.faecalis and E.faecium.The identified VRE strains were mainly vanA,vanB or vanM type based on phenotype or genotype.The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016.Enterobacteriaceae strains were still highly susceptible to carbapenems.Overall,less than 10% of these strains(excluding Klebsiella spp.) were resistant to carbapenems.The prevalence of imipenem-resistant K.pneumoniae increased from 3.0% in 2005 to 20.9% in 2017,and meropenem-resistant K.pneumoniae increased from 2.9% in 2005 to 24.0% in 2017,more than 8-fold increase.About 66.7% and 69.3% of Acinetobacter(A.baumannii accounts for 91.5%) strains were resistant to imipenem and meropenem,respectively.Compared with the data of year 2016,P.aeruginosa strains showed decreasing resistance rate to carbapenems.Conclusions Bacterial resistance is still on the rise.It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents.The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.更多还原