陕西省细菌耐药监测网2014—2016年革兰阳性菌耐药性监测

Surveillance on antimicrobial resistance of grampositive bacteria in Shaanxi Provincial Bacterial Resistance Surveillance Network from 2014 to 2016

摘要:

目的分析2014—2016年陕西省细菌耐药监测网革兰阳性菌耐药率变化情况，为革兰阳性菌感染的治疗提供理论依据。方法收集2014—2016年陕西省细菌耐药监测网各成员医院革兰阳性菌数据，依据美国临床实验室标准化协会（CLSI）2016年标准，采用WHONET 5.6软件进行数据分析。结果共收集陕西省耐药监测网42所入网医院数据。2014—2016年各年份分别收集细菌43 830、48 258、61 819株，其中革兰阳性菌分别为14 487株（33.1%）、15 303株（31.7%）和18 613（30.1%）株。革兰阳性菌来源居前5位的标本分别为痰（14 844株，30.7%）、血（8 873株，18.3%）、分泌物（6 271株，13.0%）、尿（5 225株，10.8%）和伤口脓液（2 449株，5.0%）。分离前三位的革兰阳性菌属分别为葡萄球菌属（28 878株，占59.7%）、肠球菌属（10 207株，21.1%）和链球菌属（8 824株，18.2%）。2014—2016年，耐甲氧西林金黄色葡萄球菌（MRSA）检出率分别为36.1%、45.2%和38.6%，耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为80.5%、81.0%和83.3%，未发现耐万古霉素、利奈唑胺和替考拉宁的葡萄球菌属细菌；粪肠球菌对万古霉素耐药率分别为1.7%、0.8%和0.7%，屎肠球菌对万古霉素耐药率分别为3.1%、2.0%和2.1%；非脑脊液分离的肺炎链球菌中，耐青霉素肺炎链球菌（PRSP）的检出率分别为11.8%、6.1%和4.7%。结论本地区临床分离革兰阳性菌耐药现象较为普遍，应加强对细菌耐药的监测及管理，及时了解细菌耐药情况，为临床合理用药提供依据。

Abstract:

ObjectiveTo analyze the change in antimicrobial resistance rate of grampositive bacteria in Shaanxi Provincial Bacterial Resistance Surveillance Network(BRSN) from 2014 to 2016, and provide theoretical basis for treatment of grampositive bacterial infection.MethodsData of grampositive bacteria from participating hospitals in Shaanxi Provincial BRSN between 2014 and 2016 were collected, according to 2016 standards of American Clinical and Laboratory Standards Institute (CLSI), data were analyzed with WHONET 5.6 software.ResultsData of 42 participating hospitals in Shaanxi Provincial BRSN were collected. 43 830, 48 258, and 61 819 strains of bacteria were collected in each year from 2014 to 2016, of which grampositive bacteria were 14 487 (33.1%), 15 303 (31.7%), and 18 613 (30.1%) respectively. The top 5 specimens of grampositive bacteria were sputum (n=14 844, 30.7%), blood (n=8 873, 18.3%), secretion (n=6 271, 13.0%), urine (n=5 225, 10.8%), and wound pus (n=2 449, 5.0%). The top three grampositive bacteria were Staphylococcus spp. (n=28 878, 59.7%), Enterococcus spp. (n=10 207, 21.1%), and Streptococcus spp. (n=8 824, 18.2%). From 2014 to 2016, isolation rates of methicillinresistant Staphylococcus aureus (MRSA) were 36.1%, 45.2%, and 38.6% respectively, isolation rates of methicillinresistant coagulase negative Staphylococcus (MRCNS) were 80.5%, 81.0%, and 83.3% respectively, vancomycin, linezolid, and teicoplaninresistant Staphylococcus spp. were not found; resistance rates of Enterococcus faecalis to vancomycin were 1.7%, 0.8%, and 0.7%, respectively, resistance rates of Enterococcus faecium to vancomycin were 3.1%, 2.0%, and 2.1% respectively; among Streptococcus pneumoniae isolated from noncerebrospinal fluid, isolation rates of penicillinresistant Streptococcus pneumoniae (PRSP) in three years were 11.8%, 6.1%, and 4.7% respectively.ConclusionAntimicrobial resistance of clinically isolated grampositive bacteria is more common in this region, surveillance and management of bacterial resistance should be strengthened, antimicrobial resistance of bacteria should be realized in time, so as to provide basis for rational clinical antimicrobial use.