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Surveillance of Antimicrobial Resistance in Peking Union Medical College Hospital in 2016
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摘要:
目的 了解2016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2016年1月1日至12月31日北京协和医院临床分离的11 721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2016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 11 721株非重复细菌中, 10种最常见细菌分别为:大肠埃希菌(16.3%)、肺炎克雷伯菌(11.4%)、铜绿假单胞菌(9.3%)、鲍曼不动杆菌(9.0%)、金黄色葡萄球菌(7.4%)、凝固酶阴性葡萄球菌(7.3%)、粪肠球菌(6.1%)、屎肠球菌(3.9%)、B群链球菌(3.4%)、阴沟肠杆菌(3.3%)。其中革兰阴性菌占62.7%, 革兰阳性菌占37.3%。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27.0%和68.9%。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-susceptive coagulase-negative Staphylococcus, MSCNS)菌株。仍有93.9%的MRSA对磺胺甲噁唑-甲氧苄啶敏感。MRCNS中有85.0%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)的耐药率明显低于屎肠球菌。两者中均有少数万古霉素耐药株。β溶血链球菌对青霉素的敏感率为97.4%。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50.7%(969/1913)、33.9%(488/1439)和32.1%(59/184)。肠杆菌科细菌对碳青霉烯类仍高度敏感, 总耐药率≤ 7.3%。泛耐药肺炎克雷伯菌的检出率为6.5%(87/1331), 肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为18.0%和16.6%。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为76.7%和74.4%, 对替加环素和米诺环素的耐药率最低, 分别为9.3%和26.9%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为26.3%和18.5%, 对阿米卡星的耐药率最低(8.2%)。泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别为24.8%(260/1049)和3.1%(34/1095)。 结论 肺炎克雷伯菌对碳青霉烯类的耐药率仍较高, 给临床抗感染治疗带来极大挑战。 Abstract:Objective To investigate the antimicrobial resistance of clinical bacterial isolates in Peking Union Medical College Hospital (PUMCH) in 2016. Methods A total of 11 721 non-duplicate clinical isolates were collected from January 1 to December 31 2016. Disc diffusion test (Kirby-Bauer method) and automated systems were employed to detect antimicrobial resistance. The data were analyzed by WHONET 5.6 software according to the 2016 edition of Performance Standards for Antimicrobial Susceptibility Testing issued by The Clinical and Laboratory Standards Institute (CLSI) of the United States. Results Of the 11 721 clinical isolates, the 10 most common bacteria were:Escherichia coli (16.3%), Klebsiella pneumoniae (11.4%), Pseudomonas aeruginosa (9.3%), Acinetobacter baumannii (9.0%), Staphylococcus aureus (7.4%), coagulase-negative Staphylococcus (7.3%), Enterococcus faecalis (6.1%), Enterococcus faecium (3.9%), Streptococcus agalactiae (3.4%) and Enterobacter cloacae (3.3%). Gram-negative bacilli and gram-positive cocci accounted for 62.7% and 37.3%, respectively. Methicillin-resistant strains in S. aureus (MRSA) and coagulase-negative Staphylococcus (MRCNS) accounted for 27.0% and 68.9%, respectively. The resistance rates of MRSA and MRCNS strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-susceptive coagulase-negative Staphylococcus (MSCNS) strains. 93.9% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 85.0% of MRCNS strains were susceptible to rifampin. No staphylococcal strains resistant to vancomycin, teicoplanin, and linezolid were 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. 97.4% of β-hemolytic streptococcus strains were susceptible to penicillin. Extended-spectrum β-lactamase (ESBL)-producing strains accounted for 50.7%(969/1913), 33.9%(488/1439) and 32.1%(59/184) 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 ≤ 7.3%. A few extensively resistant strains of K. pneumoniae (6.5%, 87/1331) were identified. The resistance rates of K. pneumoniae to imipenem and meropenem were 18.0% and 16.6%, respectively. About 76.7% of A. baumannii were resistant to imipenem, and 74.4% to meropenem, while the resistant rates to tigecycline (9.3%) and minocycline (26.9%) were the lowest. The resistance rates of P. aeruginosa to imipenem and meropenem were 26.3% and 18.5%, respectively, while the resistant rate (8.2%) to amikacin was the lowest. The prevalence of extensively resistant strains in A. baumannii and P. aeruginosa was 24.8% (260/1049) and 3.1% (34/1095), respectively. Conclusions The prevalence of carbapenem-resistant K. pneumonia is still higher. Infections due to carbapenem-resistant strains pose a huge challenge for clinicians. -
表 1 2016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 1913 26.0 肺炎克雷伯菌 1331 18.1 铜绿假单胞菌 1095 14.9 鲍曼不动杆菌 1049 14.3 阴沟肠杆菌 385 5.2 嗜麦芽窄食单胞菌 241 3.3 流感嗜血杆菌 205 2.8 奇异变形杆菌 184 2.5 产酸克雷伯菌 107 1.5 黏质沙雷菌 104 1.4 产气肠杆菌 87 1.2 其他 647 8.8 总计 7348 100 革兰阳性菌 金黄色葡萄球菌 866 19.8 凝固酶阴性葡萄球菌* 853 19.5 粪肠球菌 720 16.5 B群链球菌 601 13.7 屎肠球菌 460 10.5 草绿色链球菌* 423 9.7 肺炎链球菌 121 2.8 A群链球菌 23 0.5 其他 306 7.0 总计 4373 100 *仅从血液和其他无菌体液分离 
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表 2 2016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(632株) MRSA(234株) MSCNS(267株) MRCNS(586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 84.3 15.7 100 0 63.6 36.4 100 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 20.7 79.0 33.6 66.4 4.2 94.2 44.7 51.4 红霉素 56.0 43.1 85.5 13.6 61.6 36.5 81.7 17.5 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 3.1 96.4 3.9 93.9 10.6 88.2 44.5 47.4 克林霉素 27.4 67.3 66.8 30.5 13.3 80.5 37.0 59.8 利福平 0.5 99.5 17.9 81.7 3.1 96.9 14.4 85.0 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
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表 3 2016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(720株) 屎肠球菌(460株) 耐药率 敏感率 耐药率 敏感率 氨苄西林 8.3 91.7 90.6 9.4 高浓度庆大霉素 22.8 72.1 39.1 57.1 环丙沙星 28.3 58.2 90.3 4.7 红霉素 59.4 12.2 88.0 4.3 万古霉素 0.7 99.0 3.3 96.7 利奈唑胺 0.4 99.4 0 100 替考拉宁 0.1 99.4 2.0 98.0 氯霉素 22.7 75.7 2.5 95.7 四环素 73.3 26.6 56.8 41.4 利福平 66.0 15.5 82.7 16.5 磷霉素* 3.4 96.6 *仅从尿液标本分离
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表 4 2016年北京协和医院分离的肺炎链球菌、草绿色链球菌和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*
(107株)草绿色链球菌
(423株)β溶血链球菌
(634株)耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 青霉素 0 94.0 - - 0 97.4 左氧氟沙星 3.8 96.2 23.2 75.8 51.8 47.4 莫西沙星 3.8 95.3 - - - - 磺胺甲噁唑-甲氧苄啶 69.3 27.7 - - - - 红霉素 95.1 2.9 56.9 33.2 63.1 27.5 克林霉素 96.1 1.9 58.9 39.9 59.3 40.0 利奈唑胺 0 100 0 100 0 100 万古霉素 0 100 0 100 0 100 氯霉素 6.7 93.3 - - - - 头孢吡肟 - - - - - 97.8 头孢噻肟 - - 6.4 90.8 - 98.4 头孢曲松 - - 5.0 93.2 - 97.7 *分离自成人的非脑膜炎菌株
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表 5 2016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
(1913株)克雷伯菌属
(1439株)变形杆菌属
(227株)肠杆菌属
(517株)枸橼酸杆菌属
(82株)沙雷菌属
(112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 64.4 28.5 39.9 56.6 13.7 78.8 27.0 67.3 38.7 58.1 9.0 91.0 氨苄西林-舒巴坦 29.8 50.7 34.0 58.5 13.1 72.1 64.8 26.9 24.4 70.7 70.4 18.5 哌拉西林-他唑巴坦 4.2 93.3 18.4 78.5 0.9 99.1 8.8 85.3 6.2 90.1 2.7 97.3 头孢哌酮-舒巴坦 4.9 84.4 20.5 73.1 1.1 98.9 5.0 85.6 5.3 89.5 0 93.7 头孢呋辛 54.4 44.0 39.1 59.6 34.7 64.2 64.4 30.8 29.3 65.9 85.2 11.1 头孢他啶 21.7 72.9 22.2 74.4 4.4 95.6 16.6 80.5 10.1 89.9 1.8 97.3 头孢噻肟 53.6 45.9 32.3 62.3 7.1 72.8 24.7 68.3 16.2 78.4 9.2 87.8 头孢吡肟 29.5 55.3 20.1 74.9 3.2 95.0 3.2 94.8 2.6 96.2 5.4 92.9 亚胺培南 1.6 98.4 16.9 83.0 0 92.0 1.7 84.7 4.1 89.2 4.0 90.0 美罗培南 1.4 98.6 15.4 84.4 0 99.1 1.0 97.1 3.7 96.3 2.7 97.3 厄他培南 2.0 98.0 17.6 82.4 0.4 99.6 6.1 78.4 2.7 97.3 4.0 96.0 氨曲南 35.8 58.5 30.6 67.6 1.8 95.1 17.7 74.6 9.6 83.6 8.0 89.0 庆大霉素 43.3 56.2 25 74.6 17.7 74.5 7.6 91.9 19.2 80.8 8.1 91.9 阿米卡星 3.1 95.9 11.9 87.6 2.7 96.0 0.7 98.3 1.4 97.3 2.0 97.0 环丙沙星 58.4 39.7 30.3 66.2 33.8 58.2 7.3 86.9 8.3 86.1 6.0 92.0 磺胺甲噁唑-甲氧苄啶 59.9 38.9 33.3 64.8 58.0 38.9 21.9 76.9 30.1 69.9 5.9 94.1
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表 6 2016年北京协和医院分离的不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
(1049株)铜绿假单胞菌
(1095株)嗜麦芽窄食单胞
菌(241株)耐药率 敏感率 耐药率 敏感率 耐药率 敏感率 氨苄西林-舒巴坦 71.4 24.6 - - - - 替卡西林-克拉维酸 84.5 14.7 34.5 30.4 - - 哌拉西林 79.0 17.3 13.8 80.5 - - 哌拉西林-他唑巴坦 76.3 22.8 11.7 82.4 - - 头孢哌酮-舒巴坦 50.1 28.7 12.3 76.3 - - 亚胺培南 76.7 23.0 26.3 72.0 - - 美罗培南 74.4 25.4 18.5 77.9 - - 氨曲南 - - 18.4 67.5 - - 头孢他啶 74.1 25.3 11.7 85.7 - - 头孢吡肟 75.5 13.9 22.3 51.0 - - 庆大霉素 76.7 22.7 10.8 86.0 - - 阿米卡星 71.1 27.9 8.2 90.0 - - 环丙沙星 78.1 21.6 12.1 84.5 - - 左氧氟沙星 75.9 22.3 16.7 79.9 6.2 92.5 磺胺甲噁唑-甲氧苄啶 64.2 31.5 - - 2.5 97.5 米诺环素 26.9 43.9 - - 0.8 98.8 替加环素 9.3 53.3 - - - -
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表 7 2016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=186, %)
抗菌药物 耐药率 敏感率 氨苄西林 44.0 52.2 氨苄西林-舒巴坦 32.4 67.6 头孢呋辛 36.1 61.2 头孢克洛 46.9 50.3 头孢噻肟 NA 93.4 头孢曲松 NA 95.0 左氧氟沙星 NA 98.4 阿奇霉素 NA 82.7 磺胺甲噁唑-甲氧苄啶 64.3 33.0 氯霉素 7.3 84.9 NA:CLSI 2016年版无此药物的耐药折点，故无法测定其耐药率
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