全国细菌耐药监测网2014-2019年不同等级医院细菌耐药监测报告
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Surveillance on antimicrobial resistance of bacteria in different levels of hospitals:surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019
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    摘要:

    目的 研究2014-2019年全国不同等级医院细菌耐药情况。方法 从2014-2019年全国细菌耐药监测报告中提取不同等级医院的相关数据,分析三级医院及二级医院数据变迁,并进行比较。结果 2014-2019年,全部医院检出革兰阳性菌位于前五位的依次为金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、肺炎链球菌和屎肠球菌。与三级医院相比,二级医院肺炎链球菌占比更高。全部医院检出革兰阴性菌位于前五位的依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和阴沟肠杆菌。6年来,三级医院中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率有所下降(由36.2%下降至30.6%,79.9%下降至76.1%),而二级医院中MRSA和MRCNS的检出率也同样下降。耐万古霉素粪肠球菌在三级医院的检出率低于二级医院,耐万古霉素屎肠球菌在三级医院及二级医院中的检出率呈下降趋势。不同等级医院中耐亚胺培南铜绿假单胞菌的检出率变化不大,但同期比较,三级医院(18.8%~21.4%)均高于二级医院(12.3%~16.3%)。不同等级医院中耐亚胺培南鲍曼不动杆菌的检出率逐年上升,且同期比较,三级医院检出率(55.5%~60.2%)均高于二级医院(38.2%~42.8%)。三级医院及二级医院中,耐头孢噻肟大肠埃希菌检出率逐渐下降,但同期比较,三级医院的检出率(51.9%~60.9%)均高于二级医院(46.7%~56.0%)。不同等级医院中,耐亚胺培南大肠埃希菌的检出率变化不大,且均低于2%。三级医院中,耐亚胺培南肺炎克雷伯的检出率在不同等级医院中都呈现了明显的上升(由4.9%上升至11.1%),而二级医院中由3.6%上升至5.3%。结论 三级医院革兰阳性菌中特殊耐药菌比例有所下降,二级医院则变化不明显。革兰阴性菌中,耐亚胺培南的肺炎克雷伯菌及鲍曼不动杆菌检出率呈明显上升趋势,且三级医院较二级医院耐药更为严重。应继续加强抗菌药物合理应用的管理及医院感染防控,做好耐药监测工作。

    Abstract:

    Objective To study the bacterial resistance in different levels of hospitals in China from 2014 to 2019. Methods Data related to different levels of hospitals were extracted from reports of China Antimicrobial Resistance Surveillance System (CARSS) in 2014-2019, change in data of tertiary and secondary hospitals were analyzed and compared. Results From 2014 to 2019, the top 5 Gram-positive bacteria isolated from all hospitals were Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pneumoniae and Enterococcus faecium. Compared with tertiary hospitals, proportion of Streptococcus pneumoniae in secondary hospitals was higher. The top 5 Gram-negative bacteria from all hospitals were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae. During 6 years, isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative Staphylococcus (MRCNS) in tertiary hospitals decreased from 36.2% to 30.6% and 79.9% to 76.1% respectively, isolation rates of MRSA and MRCNS in secondary hospitals also decreased. Isolation rate of vancomycin-resistant Enterococcus faecalis in tertiary hospitals was lower than that in secondary hospitals, isolation rates of vancomycin-resistant Enterococcus faecium in tertiary and secondary hospitals all showed a downward trend. Isolation rate of imipenem-resistant Pseudomonas aeruginosa in different levels of hospitals didn't change much, but isolation rates in tertiary hospitals (18.8%-21.4%) were all higher than those in secondary hospitals (12.3%-16.3%) during the same period. Isolation rates of imipenem-resistant Acinetobacter baumannii in different levels of hospitals increased year by year, tertiary hospitals (55.5%-60.2%) were all higher than those in secondary hospitals (38.2%-42.8%) during the same period. Isolation rate of cefotaxime-resistant Escherichia coli in tertiary and secondary hospitals decreased gradually, but tertiary hospitals (51.9%-60.9%) were all higher than those in secondary hospitals (46.7%-56.0%) during the same period. In different levels of hospitals, isolation rate of imipenem-resistant Escherichia coli changed little, all were lower than 2%. In tertiary hospitals, isolation rate of imipenem-resistant Klebsiella pneumoniae increased significantly in different levels of hospitals (from 4.9% to 11.1%), while in secondary hospitals, it increased from 3.6% to 5.3%. Conclusion The proportion of special antimicrobial-resistant bacteria in Gram-positive bacteria in tertiary hospitals has decreased, but change is not obvious in secondary hospitals. Among Gram-negative bacteria, isolation rates of imipenem-resistant Klebsiella pneumoniae and imipenem-resistant Acinetobacter baumannii present a significant upward trend, antimicrobial resistance in tertiary hospitals is more serious than that in secondary hospitals. Management on rational use of antimicrobial agents as well as prevention and control of healthcare-associated infection should be continued to strengthen.

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  • 收稿日期:2020-11-24
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  • 在线发布日期: 2021-02-28