全国细菌耐药监测网2014—2019年胆汁细菌耐药监测报告

Antimicrobial resistance of bacteria from bile: surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019

摘要:

目的 了解全国胆道感染细菌分布和细菌耐药情况，为临床抗菌药物选择提供参考。方法 按照全国细菌耐药监测网（CARSS）技术方案，利用WHONET 5.6软件对2014—2019年CARSS成员单位上报胆汁标本分离的细菌及药敏结果数据进行分析，同一患者相同细菌仅纳入第一株菌。结果 共分析268 016株细菌，居前8位的依次为大肠埃希菌（30.9%）、肺炎克雷伯菌（12.7%）、屎肠球菌（10.1%）、粪肠球菌（8.6%）、铜绿假单胞菌（4.9%）、阴沟肠杆菌（4.5%）、鲍曼不动杆菌（2.2%）、弗劳地柠檬酸杆菌（1.8%）。药敏结果显示，6年间，大肠埃希菌和肺炎克雷伯菌对第三代头孢菌素的耐药率分别为33.7%~65.6%、23.6%~43.5%，对喹诺酮类抗生素耐药率分别为48.9%~56.6%、22.0%~28.5%，对碳青霉烯类抗生素耐药率分别为1.1%~3.7%、3.5%~7.6%；铜绿假单胞菌和鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率分别为13.4%~19.0%、29.3%~42.7%，对碳青霉烯类抗生素耐药率分别为18.0%~28.0%、44.5%~59.9%；屎肠球菌和粪肠球菌对万古霉素耐药率分别为0.6%~1.7%、0.3%~0.7%。结论 中国胆道感染病原菌以革兰阴性菌为主，主要为肠杆菌目细菌；常见病原菌对多种抗菌药物耐药明显，临床抗菌药物选择应参考耐药监测结果。

Abstract:

Objective To understand the distribution and antimicrobial resistance of bacteria in biliary tract infection in China, and provide reference for clinical antimicrobial choice. Methods According to China Antimicrobial Resistance Surveillance System(CARSS) technical program, data of bacteria isolated from bile specimen and antimicrobial susceptibility testing results reported by CARSS member hospitals in 2014-2019 were analyzed with WHONET 5.6 software, the same bacteria from the same patient was only adopted the first strain. Results A total of 268 016 bacterial strains were analyzed, the top 8 were Escherichia coli (30.9%), Klebsiella pneumoniae (12.7%), Enterococcus faecium (10.1%), Enterococcus faecalis (8.6%), Pseudomonas aeruginosa (4.9%), Enterobacter cloacae (4.5%), Acinetobacter baumannii (2.2%), and Citrobacter freundii (1.8%). Antimicrobial susceptibility testing results of 6 years showed that resistance rates of Escherichia coli and Klebsiella pneumoniae to third-generation cephalosporins were 33.7%-65.6% and 23.6%-43.5% respectively, to quinolones were 48.9%-56.6% and 22.0%-28.5% respectively, to carbapenems were 1.1%-3.7% and 3.5%-7.6% respectively; resistant rates of Pseudomonas aeruginosa and Acinetobacter baumannii to cefoperazone/sulbactam were 13.4%-19.0% and 29.3%-42.7% respectively, to carbapenems were 18.0%-28.0% and 44.5%-59.9% respectively; resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 0.6%-1.7% and 0.3%-0.7% respectively. Conclusion Gram-negative bacilli are predominant pathogens in biliary tract infection in China, the mjor bacteria were Enterobacteriaceae; pathogens are resistant to multiple antimicrobial agents, clinical antimicrobial choice should refer to antimicrobial resistance surveillance results.