Surveillance of Antimicrobial Resistance in Peking Union Medical College Hospital in 2015
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摘要:
目的 了解2015年北京协和医院临床分离细菌对抗菌药物的耐药性。 方法 收集2015年1月1日至12月31日北京协和医院临床分离的5746株非重复细菌, 采用纸片扩散法或自动化仪器法进行药敏试验, 按美国临床实验室标准化协会2015年版标准判读药敏结果, 采用WHONET 5.6软件进行数据分析。 结果 5746株非重复细菌中, 10种最常见细菌分别为:大肠埃希菌(19.4%)、铜绿假单胞菌(11.3%)、肺炎克雷伯菌(10.9%)、金黄色葡萄球菌(9.8%)、鲍曼不动杆菌(9.6%)、粪肠球菌(6.5%)、B群链球菌(5.1%)、屎肠球菌(4.6%)、凝固酶阴性葡萄球菌(2.7%)、阴沟肠杆菌(2.5%)。其中革兰阴性菌占67.5%, 革兰阳性菌占32.5%。耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus, MRCNS)的检出率分别为22.9%和77.6%。MRSA和MRCNS菌株对β内酰胺类和其他抗菌药物的耐药率明显高于甲氧西林敏感金黄色葡萄球菌(methicillin-susceptible Staphylococcus aureus, MSSA)和甲氧西林敏感凝固酶阴性葡萄球菌(methicillin-susceptible coagulase-negative Staphylococcus, MSCNS)菌株。仍有88.8%的MRSA对磺胺甲噁唑-甲氧苄啶敏感。MRCNS中有81.7%的菌株对利福平敏感。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。粪肠球菌对大多数抗菌药物(除氯霉素外)的耐药率要明显低于屎肠球菌。两者中均有少数万古霉素耐药株, 未发现对利奈唑胺耐药的肠球菌。β溶血链球菌对青霉素的敏感率为90.8%。产超广谱β-内酰胺酶的大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌的检出率分别为52.3%(582/1112)、28.9%(200/692)和26.2%(27/103)。肠杆菌科细菌对碳青霉烯类仍高度敏感, 总耐药率≤ 4.3%。泛耐药肺炎克雷伯菌的检出率为3.0%(19/630)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为76.5%和74.8%, 对头孢哌酮-舒巴坦和米诺环素的耐药率最低, 分别为49.8%和21.8%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为16.6%和11.9%, 对阿米卡星的耐药率最低(5.2%)。泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别是20.8%(115/553)和1.8%(12/650)。 结论 细菌耐药性仍对临床构成严重威胁, 临床需合理规范应用抗菌药物, 避免耐药菌株的广泛传播。 Abstract:Objective To investigate the antimicrobial resistance of clinical bacterial isolates in Peking Union Medical College Hospital (PUMCH) in 2015. Methods A total of 5746 non-duplicate clinical isolates from January 1 to December 31 2015 were collected. Disc diffusion test (Kirby-Bauer method) and automated systems were employed to detect the antimicrobial resistance. The data were analyzed by WHONET 5.6 software according to 2015 edition of antimicrobial susceptibility testing standards issued by The Clinical and Laboratory Standards Institute (CLSI) of the United States. Results Of the 5746 clinical isolates, the 10 most common bacteria were:Escherichia coli (19.4%), Pseudomonas aeruginosa (11.3%), Klebsiella pneumoniae (10.9%), Staphylococcus aureus (9.8%), Acinetobacter baumannii (9.6%), Enterococcus faecalis (6.5%), Streptococcus agalactiae (5.1%), Enterococcus faecium (4.6%), coagulase-negative Staphylococcus(2.7%), and Enterobacter cloacae(2.5%). Gram-negative bacilli and gram-positive cocci accounted for 67.5% and 32.5%, respectively. Among Staphylococcus aureus and Staphylococcus isolates, methicillin-resistant Staphyloccus aureus(MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 22.9% and 77.6%, respectively. The resistance rates of MRSA and MRCNS strains to β-lactams and other antimicrobial agents were much higher than those in methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-susceptible coagulase-negatible Staphylococcus (MSCNS) strains. 88.8% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 81.7% of MRCNS strains were susceptible to rifampin. No staphylococcal strain resistant to vancomycin, teicoplanin, or linezolid was detected. The resistance rate of E. faecalis strains to most of the antimicrobial agents tested (except Chloramphenicol) was much lower than that of E. faecium, while some strains resistant to vancomycin were found in both species. No linezolid-resistant Enterococcus strains was found. 90.8% of β-hemolytic streptococcus strains were susceptible to penicillin. Extended-spectrum β-lactamase (ESBL)-producing strains accounted for 52.3%(582/1112), 28.9%(200/692), and 26.2%(27/103) in E.coli, Klebsiella spp(K.pneumoniae and K.oxytoca), and P.mirabilis, respectively. Enterbacteriaceae strains were still highly susceptible to carbapenems, with an overall resistance rate of ≤ 4.3%. A few extensively-resistant strains of K.pneumoniae (3.0%, 19/630) were identified. About 76.5% and 74.8% of A.baumannii were resistant to imipenem and meropenem, while the resistant rates to cefoperazone-sulbactam (49.8%) and minocycline (21.8%) were the lowest. The resistance rates of P.aeruginosa to imipenem and meropenem were 16.6% and 11.9%, respectively, while the resistant rate (5.2%) to amikacin was the lowest. The prevalence of extensively-resistant strains in A.baumannii and P.aeruginosa were 20.8% (115/553) and 1.8% (12/650), respectively. Conclusions Antibiotic resistance may still pose a serious threat to clinical practice. Rational use of antibiotics should be required to prevent the spread of antimicrobial resistant strains. -
表 1 2015年北京协和医院分离细菌菌种分布
菌种 菌株数 构成比(%) 革兰阴性菌 大肠埃希菌 1112 28.7 铜绿假单胞菌 650 16.8 肺炎克雷伯菌 630 16.3 鲍曼不动杆菌 553 14.3 阴沟肠杆菌 146 3.8 嗜麦芽窄食单胞菌 141 3.6 流感嗜血杆菌 110 2.8 奇异变形杆菌 103 2.6 产酸克雷伯菌 62 1.6 黏质沙雷菌 58 1.5 产气肠杆菌 53 1.4 其他 258 6.6 总计 3876 100 革兰阳性菌 金黄色葡萄球菌 560 29.9 粪肠球菌 375 20.1 B群链球菌 290 15.5 屎肠球菌 266 14.2 凝固酶阴性葡萄球菌* 156 8.3 草绿色链球菌* 53 2.8 肺炎链球菌 48 2.6 A群链球菌 27 1.4 其他 95 5.1 总计 1870 100 *仅从血液和其他无菌体液分离 表 2 2015年北京协和医院分离的葡萄球菌属对抗菌药物的耐药率和敏感率(%)
抗菌药物 MSSA(432株) MRSA(128株) MSCNS(35株) MRCNS(121株) 耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 青霉素 81.7 18.3 100 0 63.3 36.7 100 0 苯唑西林 0 100 100 0 0 100 100 0 头孢西丁 0 100 100 0 0 100 100 0 庆大霉素 17.4 82.4 48.8 50.4 9.4 84.4 43.5 49.6 环丙沙星 7.6 90.2 69.2 29.0 5.0 90.0 61.7 37.0 红霉素 51.4 48.3 86.4 13.6 68.8 25.0 87.7 7.0 万古霉素 0 100 0 100 0 100 0 100 利奈唑胺 0 100 0 100 0 100 0 100 替考拉宁 0 100 0 100 0 100 0 100 磺胺甲噁唑-甲氧苄啶 20.0 80.0 11.2 88.8 22.6 77.4 64.3 32.2 克林霉素 21.9 75.7 67.2 32.0 16.1 83.9 35.4 60.2 利福平 1.0 99.0 31.2 68.8 0 100 18.3 81.7 MSSA:甲氧西林敏感金黄色葡萄球菌;MRSA:耐甲氧西林金黄色葡萄球菌;MSCNS:甲氧西林敏感凝固酶阴性葡萄球菌;MRCNS:耐甲氧西林凝固酶阴性葡萄球菌 表 3 2015年北京协和医院分离的粪肠球菌和屎肠球菌对抗菌药物的耐药率和敏感率(%)
抗菌药物 粪肠球菌(375株) 屎肠球菌(266株) 耐药率 敏感率 耐药率 敏感率 氨苄西林 5.8 94.2 90.7 9.3 高浓度庆大霉素 26.0 66.9 45.1 52.2 环丙沙星 28.2 59.1 87.0 7.1 红霉素 64.4 11.9 91.4 2.7 万古霉素 0.3 99.7 5.0 94.6 利奈唑胺 0 100 0 100 替考拉宁 0 100 3.5 95.7 氯霉素 27.0 70.7 2.7 94.5 利福平 64.1 19.1 80.2 19.2 磷霉素* 3.3 96.7 *仅从尿液标本分离 表 4 2015年北京协和医院分离的肺炎链球菌、α溶血和β溶血链球菌对抗菌药物的耐药率和敏感率(%)
抗菌药物 肺炎链球菌*
(46株)α溶血链球菌
(53株)β溶血链球菌
(320株)耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 青霉素 0 93.5 0 90.8 左氧氟沙星 2.4 97.6 17.6 82.4 48.7 50.9 莫西沙星 2.5 97.5 磺胺甲噁唑- 76.6 19.1 甲氧苄啶 红霉素 97.8 2.2 73.1 25 72.2 21.8 克林霉素 93.5 6.5 71.2 28.8 64.4 34.4 利奈唑胺 0 100 0 100 0 100 万古霉素 0 100 0 100 0 100 氯霉素 17.5 82.5 头孢吡肟 1.6 97.8 头孢噻肟 7.7 92.3 0 98.7 头孢曲松 7.8 92.2 0 98.4 *分离自成人的非脑膜炎菌株 表 5 2015年北京协和医院分离的肠杆菌科细菌对抗菌药物的耐药率和敏感率(%)
抗菌药物 大肠埃希菌
(1112株)克雷伯菌属
(692株)变形杆菌属
(123株)肠杆菌属
(214株)枸橼酸杆菌属
(39株)沙雷菌属
(62株)耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 哌拉西林 67.2 26.7 34.3 63.8 17.6 76.5 24.2 72.6 43.2 54.1 8.6 91.4 氨苄西林-舒巴坦 31.4 48.0 26.7 65.4 15.9 72.6 62.6 28.4 45.9 48.6 91.1 5.4 哌拉西林-他唑巴坦 4.5 93.6 13.9 83.3 1.6 96.7 11.0 80.0 21.1 7.9 0 100 头孢哌酮-舒巴坦 4.3 89.0 11.0 85.1 0 98.1 2.4 90.2 16.7 66.7 0 90.9 头孢呋辛 58.5 40.7 32.5 65.9 37.6 62.4 61.3 25.8 54.1 40.5 96.5 3.5 头孢他啶 24.7 71.3 18.6 79.4 5.0 95.0 23.1 75.0 31.6 68.4 1.7 96.6 头孢噻肟 56.7 43.0 30.9 68.9 26.1 73.9 31.6 65.3 45.7 54.3 17.2 77.6 头孢吡肟 32.5 56.0 17.9 75.3 4.1 89.3 8.1 82.0 15.8 71.1 6.6 90.2 亚胺培南 0.7 99.3 10.3 89.7 0.8 99.2 4.7 94.8 7.9 92.1 0 100 美罗培南 0.7 99.3 9.6 90.2 0.8 99.2 4.3 95.7 7.9 92.1 0 100 厄他培南 1.1 98.7 10.2 89.8 0.8 99.2 5.7 91.7 8.1 91.9 0 100 氨曲南 36.5 56.7 21.1 76.7 3.4 96.6 18.8 77.1 32.4 67.6 8.8 91.2 庆大霉素 45.0 54.7 21.8 78.1 20.8 73.3 6.7 92.7 23.7 76.3 10.3 89.7 阿米卡星 4.9 93.2 8.8 90.5 2.5 96.7 1.0 97.9 5.3 92.1 1.7 98.3 环丙沙星 62.8 35.3 21.3 76.2 32.2 62.8 9.8 85.1 26.3 71.1 3.4 91.5 磺胺甲噁唑-甲氧苄啶 61.8 37.4 27.9 70.3 53.7 43.0 15.5 83.4 34.2 65.8 3.4 96.6 表 6 2015年北京协和医院分离的非发酵糖革兰阴性杆菌对抗菌药物的耐药率和敏感率(%)
抗菌药物 鲍曼不动杆菌
(553株)铜绿假单胞菌
(650株)嗜麦芽窄食单
胞菌(141株)耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 哌拉西林 79.5 18.7 12.5 84.4 哌拉西林-他唑巴坦 77.1 22.3 8.3 88.1 氨苄西林-舒巴坦 73.2 24.7 替卡西林-克拉维酸 77.6 21.1 24.5 37.3 头孢哌酮-舒巴坦 49.8 35.9 8.4 82.9 亚胺培南 76.5 23.3 16.6 81.9 美罗培南 74.8 25.2 11.9 84.9 氨曲南 91.8 1.4 14.8 75.2 头孢他啶 75.2 24.4 10.2 88.1 头孢吡肟 77.2 12.2 25.9 34.2 庆大霉素 75.7 23 8.7 89.1 阿米卡星 73.6 24.9 5.2 94.0 环丙沙星 78.5 21.3 10.2 86.3 左氧氟沙星 75.8 21.7 13.1 83.3 11.0 87.5 磺胺甲噁唑-甲氧苄啶 58.8 35.9 3.6 94.2 米诺环素 21.8 45.1 0.7 98.5 表 7 2015年北京协和医院分离自成人的流感嗜血杆菌对抗菌药物的耐药率和敏感率(n=102,%)
抗菌药物 耐药率 敏感率 氨苄西林 39.2 61.8 氨苄西林-舒巴坦 26.5 73.5 头孢呋辛 26.0 71.0 头孢克洛 39.2 57.7 头孢噻肟 NA 90.0 头孢曲松 NA 91.0 左氧氟沙星 NA 98.0 环丙沙星 13.0 87.0 阿奇霉素 NA 83.0 磺胺甲噁唑-甲氧苄啶 59.8 38.1 氯霉素 10.1 84.8 NA:CLSI 2015年版无此药物的耐药折点,故耐药率无法测定 -
[1] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. M100-S24[S]. Wayne, PA: CLSI, 2014. [2] Jones RN, Ferraro MJ, Reller LB, et al. Multicenter studies of tigecycline disk diffusion susceptibility results for Acinetobacter spp.[J]. J Clin Microbiol, 2007, 45:227-230. doi: 10.1128/JCM.01588-06 [3] 张小江, 杨启文, 孙宏莉, 等. 2014北京协和医院细菌耐药性监测[J].中国感染与化疗杂志, 2014, 16:315-322. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgkgrhlzz201603015 [4] 胡付品, 朱德妹, 汪复, 等. 2014年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志, 2015, 15:401-410. [5] Parisi SG, Bartolini A, Santacatterina E, et al. Prevalence of Klebsiella pneumoniae strains producing carbapenemases and increase of resistance to colistin in an Italian teaching hospital from January 2012 To December 2014[J]. BMC Infec Dis, 2015, 15:244-253. doi: 10.1186/s12879-015-0996-7 [6] Yamamoto M, Pop-Vicas AE. Treatment for infections with carbapenem resistant Enterobacteriaceae:what options do we still have?[J]. Critical Care, 2014, 18:229-236. doi: 10.1186/cc13949 [7] Paul M, Carmeli Y, Durante-Mangoni E, et al. Combination therapy for carbapenem-resistant Gram-negative bacteria[J]. J Antimicrob Chemother, 2014, 69:2305-2309. doi: 10.1093/jac/dku168 [8] Tzouvelekis LS, Markogiannakis A, Piperaki E, et al. Treating infections caused by carbapenemase-producing Enterobacteriaceae[J]. Clin Microbiol Infect, 2014, 20:862-872. doi: 10.1111/1469-0691.12697
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