【摘要】 目的 了解2015—2021年CHINET所属52所医院临床分离大肠埃希菌对各类抗菌药物的耐药性及变迁。方法 按照CHINET耐药监测网统一方案进行大肠埃希菌的抗菌药物敏感性试验。采用WHONET 5.6及SPSS 20.0软件进行数据分析。结果 2015—2021年共分离到非重复大肠埃希菌临床分离株289 760株，主要分离自尿液标本[（44.7±3.2）%]，女性尿标本占比高于男性（59.0%对29.5%）；未成年人呼吸道及脑脊液标本分离株占比均高于成人（16.7%对7.8%,0.8%对0.1%）；上述差异均有统计学意义（P值<0.05）。内科分离株占比最多[（28.9±2.8）%]，有增长趋势。7年间，产ESBL大肠埃希菌及碳青霉烯类耐药大肠埃希菌（carbapenem resistant Escherichia coli, CREco）总检出率分别为55.9%及1.8%。产ESBL大肠埃希菌历年检出率三级医院最高。儿童医院CREco历年检出率高于二、三级医院。三级医院产ESBL大肠埃希菌、儿童医院产ESBL大肠埃希菌和CREco检出率均有下降趋势。二、三级医院CREco检出率有缓慢上升趋势。历年抗生素耐药率变化趋势缓慢。碳青霉烯类药物（亚胺培南、美罗培南）是β内酰类药物中抗菌活性最好的药物（耐药率≤2.1%）。β内酰酶抑制剂复方制剂（哌拉西林-他唑巴坦、头孢哌酮-舒巴坦）、氨基糖苷类药物（阿米卡星）以及呋喃妥因和磷霉素（分离自尿标本菌株）耐药率均在10%以内。不同等级医院和不同科室分离的大肠埃希菌对抗菌药物的耐药率存在差异，尤其对头孢唑林及环丙沙星，分离自非ICU未成年住院患者的菌株耐药率明显低于其他科室患者（P<0.05）。对于大多数药物，分离自ICU的大肠埃希菌耐药率（除替加环素外）高于其他科室；三级医院分离株（替加环素、多黏菌素B、头孢吡肟、碳青霉烯类除外）耐药率高于二级医院和儿童医院。结论 大肠埃希菌是重要致病菌，超半数的临床分离株产ESBL。虽然CREco总体检出率低，但在二、三级医院的检出率近年有上升趋势，需特别关注。更多还原

【Abstract】 Objective To investigate the changing antibiotic resistance profiles of E. coli isolated from patients in the 52 hospitals participating in the CHINET program from 2015 to 2021. Methods Antimicrobial susceptibility was tested for clinical isolates of E. coli according to the unified protocol of CHINET program. WHONET 5.6 and SPSS 20.0 software were used for data analysis.Results A total of 289 760 nonduplicate clinical strains of E. coli were isolated from 2015 to 2021, mainly from urine samples(44.7 ±3.2)%. The proportion of E. coli strains isolated from urine samples was higher in females than in males(59.0% vs 29.5%). The proportion of E. coli strains isolated from respiratory tract and cerebrospinal fluid samples was significantly higher in children than in adults(16.7% vs 7.8%, 0.8% vs 0.1%, both P < 0.05). The isolates from internal medicine department accounted for the largest proportion(28.9 ± 2.8)% with an increasing trend over years. Overall, the prevalence of ESBLs-producing E. coli and carbapenem resistant E. coli(CREco) was 55.9% and 1.8%, respectively during the 7-year period. The prevalence of ESBLs-producing E. coli was the highest in tertiary hospitals each year from 2015 to 2021 compared to secondary hospitals. The prevalence of CREco was higher in children’s hospitals compared to secondary and tertiary hospitals each year from 2015 to 2021. The prevalence of ESBLs-producing E. coli in tertiary hospitals and children’s hospitals and the prevalence of CREco in children’s hospitals showed a decreasing trend over the 7-year period. The prevalence of CREco in secondary and tertiary hospitals increased slowly. Antibiotic resistance rates changed slowly from 2015 to 2021. Carbapenem drugs(imipenem, meropenem) were the most active drugs among β-lactams against E. coli(resistance rate ≤ 2.1%). The resistance rates of E. coli to β-lactam/β-lactam inhibitor combinations(piperacillin-tazobactam, cefoperazone-sulbactam), aminoglycosides(amikacin), nitrofurantoin and fosfomycin(for urinary isolates only) were all less than 10%. The resistance rate of E. coli strains to antibiotics varied with the level of hospitals and the departments where the strains were isolated, especially for cefazolin and ciprofloxacin, to which the resistance rate of E. coli strains from children in non-ICU departments was significantly lower than that of the strains isolated from other departments(P < 0.05). The E. coli isolates from ICU showed higher resistance rate to most antimicrobial agents tested(excluding tigecycline) than the strains isolated from other departments. The E. coli strains isolated from tertiary hospitals showed higher resistance rates to the antimicrobial agents tested(excluding tigecycline, polymyxin B, cefepime and carbapenems) than the strains from secondary hospitals and children’s hospitals. Conclusions E. coli is an important pathogen causing clinical infection. More than half of the clinical isolates produced ESBL. The prevalence of CREco is increasing in secondary and tertiary hospitals over the 7-year period even though the overall prevalence is still low. This is an issue of concern.更多还原