知识与财富的链接
目的对四川省细菌耐药监测网成员单位2015—2018年度无菌体液(未包括血液)的细菌分布及耐药情况进行统计分析,为本省临床合理应用抗菌药物提供依据。方法按照监测方案,采用标准纸片扩散法、E-test法或自动化仪器检测法,依据美国临床实验室标准化研究协会(CLSI)2018年标准,用WHONET5.6软件进行数据分析。结果2015—2018年间四川地区无菌体液共分离出29754株非重复的细菌,其中革兰阳性菌11351株,占38.1%,革兰阴性菌18403株,占61.9%。无菌体液中最常见的细菌依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、屎肠球菌和表皮葡萄球菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为28.3%和63.9%。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)。屎肠球菌中分别检出0.5%(9株)对利奈唑胺耐药和2.2%(40株)对万古霉素耐药的菌株,粪肠球菌中发现1.7%(22株)对利奈唑胺耐药和0.3%(4株)对万古霉素耐药的菌株。耐万古霉素屎肠球菌(VRE)由4%降至1.8%,而耐利奈唑胺屎肠球菌由1.3%降至0。无菌体液标本中产ESBL大肠埃希菌和肺炎克雷伯菌的检出率分别为45.8%和25.6%,大肠埃希菌和肺炎克雷伯菌对碳氢霉烯类仍然保持较高的活性。非发酵菌对碳青霉烯类抗生素耐药率较高,其中鲍曼不动杆菌对亚胺培南的耐药率已大于65%。结论四川地区无菌体液分离细菌对常见抗菌药物的耐药率部分仍呈增长趋势,尤其是耐碳青霉烯肺炎克雷伯菌。对万古霉素耐药的屎肠球菌分离率较高。非发酵菌特别是鲍曼不动杆菌的耐药形势严峻。应充分利用本地细菌耐药监测结果进行感控管理,促进抗菌药物合理应用。
Objective To statistically analyze the bacterial distribution and drug resistance of sterile body fluids during 2015—2018 (not including blood) in Sichuan province as a member of the bacterial drug resistance monitoring network, so as to provide a basis for the rational clinical application of antimicrobial agents in this province. Methods According to the monitoring scheme, the standard paper diffusion method, the E-test method or the automated instrument detection method were adopted. According to the CLSI 2018 standard, the data were analyzed with WHONET 5.6 software. Results A total of 30,299 non-repeating bacteria were isolated from Sichuan during 2015—2018, including 1,135 Gram-positive bacteria (38.1%) and 18,403 Gram-negative bacteria (61.9%). The most common bacteria in sterile body fluids are E. coli, K. pneumoniae, S. aureus, Enterococcus and S. epidermidis. The detection rates of MRSA and MRCNS were 28.3% and 63.9%, respectively. The drug resistance rates of MRSA and MRCNSto most tested drugs were significantly higher than those of methicillin-sensitive strains (MSSA and MSCNS). Strains resistant to linezolid (0.5%, 9 strains) and vancomycin (up to 2.2%, 40 strains) were detected in E. faecalis, while strains resistant to linezolid (1.7%, 22 strains) and vancomycin (0.3%, 4 strains) were found in E. faecalis. Forms of vancomycin-resistant Enterococcus (VRE) decreased from 4% to 1.8%, while forms of linezolid Enterococcus (VRE) decreased from 1.3% to 0. The detection rates of ESBL E. coli and K. pneumoniae were 45.8% and 25.6%, respectively. E. coli and K. pneumoniae still maintained high activity against hydrocarbon enzytenes. The drug resistance rate of non-fermenting bacteria to carbapenems was relatively high, and that of A. baumannii to imipenem was more than 65%. Conclusion The drug resistance rate of pathogenic bacteria isolated from sterile body fluids in Sichuan province is still increasing, especially K. pneumoniae resistant to carbapenems. The isolation rate of E. faecalis resistant to vancomycin was relatively high. The situation of drug resistance of non-fermentable bacteria especially A. baumannii is serious. We should make full use of the local bacterial resistance monitoring results for infection control management and promote the rational use of antimicrobial
