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Analysis of Antimicrobial Resistance in Peking Union Medical College Hospital in 2019
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摘要:
目的 了解2019年北京协和医院分离的常见细菌对抗菌药物的耐药性。 方法 回顾性分析2019年1月1日至12月31日从北京协和医院分离的11 404株非重复细菌的药敏结果。 结果 11 404株细菌中革兰氏阴性菌占63.8%(7276/11 404)、革兰氏阳性菌占36.2%(4128/11 404)。葡萄球菌属中，甲氧西林耐药的金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)和甲氧西林耐药的凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus, MRCNS)的检出率分别为18.9%(191/1009)和77.3%(659/853)，两者对红霉素的耐药率均较高(79.6%、83.2%)。肠球菌属中，屎肠球菌和粪肠球菌的检出率别为38.2% (437/1143)和54.6%(624/1143)，对利奈唑胺(0.2%、0.3%)、万古霉素(4.3%、0.2%)和替考拉宁(3.0%、0)的耐药率较低。链球菌属中，肺炎链球菌、α溶血链球菌、A群和B群β溶血链球菌的检出率分别为12.8%(130/1012)、37.9%(384/1012)、4.2%(43/1012)和39.0%(395/1012)，各菌种对红霉素、阿奇霉素和克林霉素的耐药率较高，其中肺炎链球菌和A群β溶血链球菌对此3种抗菌药物的耐药率均≥88.7%。肠杆菌科中，碳青霉烯类耐药肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae, CRE)、肺炎克雷伯菌广泛耐药(extensive drug resistance, XDR)菌株的检出率分别为7.1%(308/4324)、4.7%(60/1273)；肠杆菌科细菌对替加环素、碳青霉烯类和阿米卡星的耐药率较低。不发酵糖革兰氏阴性杆菌中，鲍曼不动杆菌对替加环素的耐药率最低(6.9%)，对哌拉西林的耐药率最高(93.3%)；铜绿假单胞菌对阿米卡星的耐药率最低(4.5%)，对左氧氟沙星的的耐药率最高(22.6%)；鲍曼不动杆菌和铜绿假单胞菌中XDR菌株的检出率为12.3%(117/949)和1.8%(21/1137)。流感嗜血杆菌中，β-内酰胺酶的阳性率为34.1% (45/132)；流感嗜血杆菌对氨苄西林的耐药率最高(62.9%)，除氯霉素外对其他抗菌药物的耐药率为33.3%~48.4%。 结论 2019年北京协和医院分离的常见细菌对常用抗菌药物有不同程度的耐药，可能对抗菌药物的合理使用和科学管理有指导作用。 Abstract:Objective To investigate the antimicrobial resistance of clinical bacterial isolates in Peking Union Medical College Hospital (PUMCH) in 2019. Methods The antimicrobial resistance of 11 404 non-duplicated common bacteria isolated from PUMCH during January 1 to December 31, 2019 were retrospectively analyzed. Results In the totally 11 404 clinical isolates, Gram-negative bacilli and gram-positive cocci accounted for 63.8% (7276/11 404) and 36.2% (4128/11 404), respectively. Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant coagulase-negative Staphylococcus(MRCNS) accounted for 18.9%(191/1009) and 77.3% (659/853), respectively, both of which had a high resistance rate to erythromycin (79.6%, 83.2%). Enterococcus faecium and Enterococcus faecalis accounted for 38.2% (437/1143) and 54.6% (624/1143) in Enterococci, respectively; and the resistance rates to linezolid (0.2%, 0.3%), vancomycin (4.3%, 0.2%) and teicoplanin (3.0%, 0) were low. The detection rates of Streptococcus pneumoniae, α -hemolytic Streptococcus, group A and group B β -hemolytic Streptococcus were 12.8% (130/1012), 37.9%(384/1012), 4.2% (43/1012) and 39.0% (395/1012) in Streptococcus, respectively. The resistance rates of all strains to erythromycin, azithromycin and clindamycin were more than 88.7% in Streptococcus pneumoniae and group β -hemolytic Streptococcus. Among the Enterobacteriaceae, the detection rates of carbapenem resistant Enterobacteriaceae(CRE) and extensive drug resistance (XDR) strains in Klebsiella pneumoniae were 7.1%(308/4324) and 4.7% (60/1273), respectively. The resistance rates of Enterobacteriaceae to tigecycline, carbapenems and amikacin were low. Among the non-fermentative Gram negative bacilli, Acinetobacter baumannii had the lowest resistance rate to tigecycline (6.9%) and the highest resistance rate to piperacillin (93.3%); Pseudomonas aeruginosa had the lowest resistance rate to amikacin (4.5%) and the highest resistance rate to levofloxacin (22.6%). The detection rates of XDR strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 12.3% (117/949) and 1.8%(21/1137), repectively. Among Haemophilus influenzae, the positive rate of β-lactamase was 34.1%(45/132); the resistance rate to ampicillin was the highest (62.9%); the resistance rate to other antibiotics except chloramphenicol were 33.3%-48.4%. Conclusions The common bacteria isolated from PUMCH in 2019 have different degrees of resistance to commonly used antibiotics, which may play a guiding role in the rational use and scientific management of antibiotics. 作者贡献：刘文静负责收集、整理、分析数据，并撰写文章；徐英春、张小江负责修改并审阅文章；肖盟负责分析数据；杨启文、王瑶、孙宏莉、赵颖、窦红涛、刘亚丽、郭莉娜、朱任媛、张丽负责收集数据。利益冲突： 无 -
表 1 2019年北京协和医院分离细菌菌种分布
菌种 菌株数量[n(%)] 大肠埃希菌 1979(17.4) 克雷伯菌属 1384(12.1) 肠球菌属 1143(10.0) 铜绿假单胞菌 1137(10.0) 鲍曼不动杆菌 1055(9.3) 金黄色葡萄球菌 1009(8.8) 凝固酶阴性葡萄球菌* 853(7.5) 肠杆菌属 440(3.9) β溶血链球菌 438(3.8) α溶血链球菌 384(3.4) 嗜麦芽窄食单胞菌 246(2.2) 变形杆菌属 186(1.6) 流感嗜血杆菌 132(1.2) 肺炎链球菌 130(1.1) 柠檬酸杆菌属 119(1.0) 沙雷菌属 82(0.7) 洋葱伯克霍尔德菌 57(0.5) 其他 630(5.5) 总计 11 404(100) *分离自血液和无菌部位的临床菌株 
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表 2 葡萄球菌属对抗菌药物的耐药率和敏感率(%)
抗菌药物 MSSA(n=818) MRSA(n=191) MSCNS(n=194) MRCNS(n=659) 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 77.2 22.8 100 0 64.4 35.6 100 0 苯唑西林 0 100 100 0 0 100 100 0 庆大霉素 9.0 87.5 22.5 76.4 3.1 93.8 19.6 63.1 左氧氟沙星 8.8 90.5 38.1 61.9 9.9 90.1 68.2 30.5 红霉素 48.5 50.4 79.6 20.4 55.3 44.1 83.2 15.8 利福平 0.4 99.4 9.9 88.5 1.0 99.0 20.5 78.8 复方新诺明 21.4 78.5 5.8 94.2 15.5 84.5 32.3 67.5 克林霉素 18.9 80.3 57.8 42.2 11.8 88.2 32.4 67.1 利奈唑胺 0 100 0 100 0 100 0 100 万古霉素 0 100 0 100 0 100 0 100 替考拉宁 0 100 0 100 0 100 0 100 MSSA：甲氧西林敏感的金黄色葡萄球菌；MRSA：甲氧西林耐药的金黄色葡萄球菌；MSCNS：甲氧西林敏感的凝固酶阴性葡萄球菌；MRCNS：甲氧西林耐药的凝固酶阴性葡萄球菌
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表 3 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(n=624) 屎肠球菌(n=437) 耐药率 敏感率 耐药率 敏感率 青霉素 7.4 92.2 83.6 15.9 氨苄西林 13.3 86.7 83.3 16.7 高浓度庆大霉素 22.2 72.2 18.8 81.2 利福平 55.0 30.0 77.8 16.7 环丙沙星 41.8 39.6 96.8 1.1 左氧氟沙星 23.2 74.4 75.5 18.7 磷霉素* 9.9 84.3 NA NA 红霉素 55.5 4.3 80.9 4.0 呋喃妥因 1.7 96.7 64.2 21.0 利奈唑胺 0.3 99.7 0.2 99.8 万古霉素 0.2 99.8 4.3 95.7 替考拉宁 0 100 3.0 97.0 氯霉素 20.0 80.0 8.3 66.7 *仅分离自尿液的临床菌株；NA：美国临床实验室标准化协会无折点
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表 4 肺炎链球菌、α和β溶血链球菌对抗菌药物的耐药率和敏感率(%)
抗菌药物 青霉素敏感的肺炎
链球菌(n=120)青霉素非敏感的肺炎
链球菌(n=9)α溶血链球菌
(n=384)β溶血链球菌 A群(n=43) B群(n=395) 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 青霉素 0 100 33.3 0 2.1 73.7 0 100 0 100 氨苄西林 NA NA NA NA 0 92.0 0 100 0 100 左氧氟沙星 8.5 90.7 11.1 88.9 14.9 84.3 2.3 97.7 57.9 40.1 莫西沙星 6.2 92.0 0 88.9 NA NA NA NA NA NA 复方新诺明 67.3 30.0 87.5 12.5 NA NA NA NA NA NA 阿奇霉素 88.7 6.1 100 0 68.0 27.1 90.5 7.1 60.0 40.0 红霉素 92.3 6.0 100 0 62.7 28.3 89.7 7.7 74.8 16.8 克林霉素 92.2 6.9 100 0 63.6 34.1 87.5 12.5 58.3 33.3 利奈唑胺 0 100 0 100 0 100 0 100 0 100 万古霉素 0 100 0 100 0 100 0 100 0 100 氯霉素 7.6 92.4 0 100 1.8 96.5 2.4 92.9 10.0 90.0 头孢克洛 - - - - 4.1 91.8 NA NA NA NA 头孢曲松 - - - - 4.1 94.0 0 100 0 100 头孢噻肟 - - - - 6.0 92.4 0 100 0 100 头孢吡肟 - - - - 1.9 96.8 0 100 0 100 -：无相关药敏数据；NA：同表 3
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表 5 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
(n=1979)克雷伯菌属
(n=1384)肠杆菌属
(n=440)变形杆菌属
(n=186)沙雷菌属
(n=82)柠檬酸杆菌属
(n=119)CRE
(n=308)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 耐药率 敏感率 哌拉西林 63.6 25.8 31.3 56.7 47.4 36.8 14.3 57.1 - - 40.0 60.0 86.7 6.7 阿莫西林-克拉维酸 8.9 72.0 21.6 71.0 82.8 12.5 2.9 93.5 IR IR 25.8 54.8 97.2 0.8 头孢哌酮-舒巴坦 5.0 91.4 17.9 80.0 14.9 81.8 1.1 95.5 15.2 82.3 10.6 84.1 93.9 3.7 哌拉西林-他唑巴坦 5.8 90.9 18.5 76.2 26.6 66.3 1.0 98.9 16.0 80.2 13.6 72.0 95.3 3.4 头孢他啶 19.6 79.1 23.5 75.3 34.8 63.4 2.2 96.7 16.2 83.8 25.4 72.9 97.4 2.3 头孢曲松 39.4 59.2 27.8 70.8 40.0 55.0 17.1 82.9 - - - - 88.2 5.9 头孢噻肟 42.2 57.8 29.7 70.3 57.9 42.1 37.5 62.5 - - - - 93.3 6.7 头孢吡肟 9.5 77.3 25.2 74.7 12.5 86.8 0.5 95.1 7.4 92.6 2.5 94.1 87.0 10.4 头孢西丁 13.8 77.7 19.8 77.7 87.5 9.4 3.3 92.9 0 83.3 46.8 46.8 96.5 1.5 氨曲南 28.5 64.5 27.5 71.0 33.5 64.1 1.7 97.8 19.7 80.3 25.9 71.6 94.1 4.9 厄他培南 1.9 97.8 14.5 84.9 9.5 85.3 0 100 18.9 81.1 4.3 95.7 97.4 2.3 亚胺培南 1.7 98.3 13.7 86.0 6.1 93.5 0.6 97.4 17.5 82.5 4.3 95.7 88.3 9.1 美罗培南 1.7 98.3 13.8 86.0 6.2 93.4 0 100 16.0 82.7 4.2 95.8 87.2 11.1 阿米卡星 1.6 98.1 8.2 91.8 1 98.6 3.3 96.2 2.5 98.0 0 100 35.2 64.5 庆大霉素 37.8 61.7 22.4 76.9 12.7 85.6 12.4 80.2 6.8 93.2 11.6 86.6 70.1 27.2 环丙沙星 54.0 42.7 26.6 68.1 13.6 78.1 24.0 70.4 3.9 89.5 16.2 78.6 82.9 12.7 左氧氟沙星 56.8 16.3 29.6 57.4 18.2 67.1 32.6 54.9 10.0 83.8 23.1 68.4 87.0 8.1 复方新诺明 53.9 46.1 29.3 70.6 18.3 81.5 45.9 54.1 2.2 97.8 25.6 74.4 64.5 35.2 磷霉素* 6.5 93.0 NA NA NA NA NA NA NA NA NA NA NA NA 米诺环素 15.7 76.5 15.3 73.7 14.5 76.2 76.2 13.4 2.7 84.0 16.4 74.1 33.0 45.4 替加环素 0.2 99.7 6.2 90.0 7.2 91.3 IR IR 2.6 96.1 0.9 94.6 19.5 71.8 CRE：碳青霉烯类耐药的肠杆菌科细菌；-：同表 4；*、NA：同表 3；IR：天然耐药
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表 6 不发酵糖革兰氏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(n=949) 铜绿假单胞菌(n=1137) 嗜麦芽窄食单胞菌(n=246) 洋葱伯克霍尔德菌(n=57) 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 93.3 6.7 8.9 91.1 IR IR IR IR 头孢哌酮-舒巴坦 56.0 26.2 16.1 72.3 NA NA NA NA 氨苄西林-舒巴坦 78.6 16.6 IR IR IR IR IR IR 哌拉西林-他唑巴坦 85.0 14.2 14.4 85.6 IR IR NA NA 头孢他啶 83.9 15.2 12.0 84.3 - - 11.5 82.7 头孢曲松 87.9 0.0 IR IR IR IR NA NA 头孢噻肟 89.3 0.0 IR IR IR IR NA NA 头孢吡肟 75.4 14.9 7.5 85.0 NA NA NA NA 氨曲南 IR IR 7.0 73.1 IR IR NA NA 亚胺培南 84.0 15.9 20.4 79.0 IR IR NA NA 美罗培南 84.2 15.6 11.7 85.5 IR IR 25.5 49.0 阿米卡星 81.2 18.1 4.5 94.2 IR IR NA NA 庆大霉素 73.7 26.3 7.6 89.6 IR IR NA NA 环丙沙星 85.2 14.4 10.6 84.4 NA NA NA NA 左氧氟沙星 74.7 14.4 22.6 72.4 11.4 87.3 - - 复方新诺明 73.6 25.9 IR IR 2.4 95.5 0 98.1 米诺环素 48.8 34.1 NA NA 0 97.1 1.9 98.1 替加环素 6.9 66.1 IR IR NA NA NA NA -：同表 4；NA：同表 3；IR：同表 5
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表 7 流感嗜血杆菌对抗菌药物的耐药率和敏感率(%)
抗菌药物 菌株数(n=132) 耐药率 敏感率 氨苄西林 62.9 34.1 阿莫西林-克拉维酸 38.6 61.4 氨苄西林-舒巴坦 33.3 66.7 头孢呋辛 40.6 58.6 头孢克洛 48.4 48.4 头孢噻肟 N 100 环丙沙星 N 100 阿奇霉素 N 82.9 复方新诺明 36.9 55.4 氯霉素 0 97.5 N：美国临床实验室标准化协会中只有敏感折点，无耐药折点
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