【摘要】 目的监测国内各省市主要医疗机构临床分离菌株对抗菌药物的敏感性。方法对国内主要地区44所医院临床分离菌按CHINET统一监测方案进行抗菌药物敏感性试验。按2018年CLSI文件标准判断结果。结果收集2018年1-12月上述医院临床分离菌共244 843株,其中革兰阳性菌占28.2%,革兰阴性菌占71.8%。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34.0%和78.9%。MRSA和MRCNS对绝大多数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 92.2%的菌株对甲氧苄啶-磺胺甲■唑敏感;MRCNS中有88.0%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。肺炎链球菌非脑膜炎株儿童株中PSSP(89.4%)和PRSP(1.7%)所占比例较2016年有所下降。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17%(除克雷伯菌属外)。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2018年的25.0%和26.3%。与此同时,肺炎克雷伯菌每年的占比亦呈逐步上升趋势。不动杆菌属(鲍曼不动杆菌占92.5%)对亚胺培南和美罗培南的耐药率分别为73.2%和73.9%;铜绿假单胞菌对上述两药的耐药率分别为30.7%和25.8%;耐药率均呈上升趋势。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,以发挥细菌耐药监测工作的最大价值。更多还原

【Abstract】 Objective To investigate the susceptibility and resistance profile of clinical isolates from hospitals across China.Methods A total of 44 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 2018 breakpoints.Results A total of 244,843 clinical isolates were collected from Junuary to December 2018,of which gram negative organisms and gram positive cocci accounted for 71.8% and 28.2% respectively.Methicillin-resistant strains in S.aureus (MRSA) and coagulase negative Staphylococcus (MRCNS) accounted for an average of 34.0% and 78.9%,respectively.The resistance rates of MR strains to most of other antimicrobial agents were much higher than those of MS strains.However,92.2% of MRSA strains were still susecptilbe to trimethoprim-sulfamethoxazole,while 88.0% of MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin.In Enterococcus spp.,the resistance rates of E.faecalis strains to most tested drugs were much lower than those of E.faecium.A few strains of both species were resistant to vancomycin.As for non-meningitis S.pneumoniae strains,unlike the isolates from adults,the prevalence of PSSP (89.4%) or PRSP (1.7%) strains isolated from children were lower than those isolated in 2016.The strains of Enterobacteriaceae were still highly susceptible to carbapenems.Overall,less than 17% of these strains were resistant to carbapenems (except Klebsiella spp.).A remarkable increase of resistance to imipenem and meropenem was seen in K.pneumoniae from 3.0% to 25.0% and from 2.9% to 26.3% during the period from 2005 to 2018.The proportion of K.pneumoniae was also increasing stably among gram-negative bacilli.About 73.2% and 73.9% of Acinetobacter spp.(A.baumannii accounts for 92.5%) strains were resistant to imipenem and meropenem,respectively.About 30.7% and 25.8% of the P.aeruginosa isolates were resistant to imipenem and meropenem respectively,higher than the data of year 2017.Conclusions Bacterial resistance to commonly used antibiotics is still on the rise.It is necessary to strengthen hospital infection control and antimicrobial stewardship.It is also important to insist on bacterial resistance surveilliance and improve the communication between laboratory and clinicians.更多还原