全国细菌耐药监测网2021年血液科患者分离细菌耐药监测报告

Antimicrobial resistance of bacteria isolated from patients in department of hematology: surveillance report from China Antimicrobial Resistance Surveillance System, 2021

摘要:

目的 了解全国血液科患者分离的常见病原菌分布及耐药性, 为血液病感染患者抗菌药物的合理使用提供科学依据。 方法 采用WHONET 5.6软件, 分析2021年全国细菌耐药监测网(CARSS)网点医院按CARSS技术方案上报的血液科患者分离病原菌的分布及耐药性。 结果 共收集血液科患者非重复分离菌74 300株, 其中革兰阴性菌53 970株(72.6%), 革兰阳性菌20 330株(27.4%)。病原菌分离率居首位的为大肠埃希菌(16 051株, 21.6%), 其次分别为肺炎克雷伯菌(11 214株, 15.1%)、铜绿假单胞菌(6 071株, 8.2%)、金黄色葡萄球菌(4 768株, 6.4%)和屎肠球菌(3 600株, 4.8%)。分离菌株中血标本占首位(24.6%), 其次为痰(24.0%)和尿标本(16.6%)。对亚胺培南和美罗培南的耐药率: 大肠埃希菌分别为4.4%、4.3%, 肺炎克雷伯菌分别为10.8%、11.5%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为16.7%、12.8%。鲍曼不动杆菌除对多黏菌素B、米诺环素和替加环素耐药率均＜10%, 对其他测试抗菌药物的耐药率为14.3%~27.0%。流感嗜血杆菌对氨苄西林耐药率为64.5%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为28.8%、82.1%, 未发现对万古霉素和利奈唑胺耐药的金黄色葡萄球菌。屎肠球菌和粪肠球菌对万古霉素的耐药率分别为3.2%、0.2%, 肺炎链球菌对青霉素的耐药率为1.6%, 未发现对万古霉素和利奈唑胺耐药的链球菌。 结论 血液科患者分离的细菌以革兰阴性杆菌为主, 耐碳青霉烯类肺炎克雷伯菌及耐利奈唑胺的葡萄球菌、肠球菌需引起重视, 应加强病原菌的耐药监测, 合理使用抗菌药物。

Abstract:

Objective To understand the distribution and antimicrobial resistance of bacteria isolated from patients in department of hematology in China, and provide scientific basis for rational clinical antimicrobial use in patients with infection from department of hematology. Methods According to the technical program from China Antimicrobial Resistance Surveillance System (CARSS), distribution and antimicrobial resistance of clinically isolated bacteria from patients in department of hematology in 2021 were analyzed by WHONET 5.6 software. Results A total of 74 300 non-repetitive clinically isolated strains were collected from patients from department of hematology in CARSS hospitals, including 53 970 (72.6%) Gram-negative bacteria and 20 330 (27.4%) Gram-positive bacteria. Escherichia coli was the most frequently isolated bacteria (n=16 051, 21.6%), followed by Klebsiella pneumoniae (11 214, 15.1%), Pseudomonas aeruginosa (6 071, 8.2%), Staphylococcus aureus (4 768, 6.4%) and Enterococcus faecium (3 600, 4.8%). The most common specimen source was blood (24.6%), followed by sputum (24.0%) and urine (16.6%). The resistance rates of Escherichia coli to imipenem and meropenem were 4.4% and 4.3%, respectively, and those of Klebsiella pneumoniae to imipenem and meropenem were 10.8% and 11.5%, respectively. Resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 16.7% and 12.8%, respectively. Resistance rates of Acinetobacter baumannii to most tested antimicrobial agents were 14.3%-27.0%, except polymyxin B, minocycline and tigecycline, which were less than 10%. The resistance rate of Haemophilus influenzae to ampicillin was 64.5%. Among Staphylococcus aureus and coagulase negative Staphylococcus, isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative Staphylococcus (MRCNS) were 28.8% and 82.1%, respectively. No Staphylococcus aureus strains were found to be resistant to vancomycin and linezolid. The resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 3.2% and 0.2%, respectively, and that of Streptococcus pneumoniae to penicillin was 1.6%. No Streptococcus strains were found to be resistant to vancomycin and linezolid. Conclusion Gram-negative bacteria are the major bacteria isolated from department of hematology. Carbapenem-resistant Klebsiella pneumoniae, linezolid-resistant Staphylococcus and linezolid-resistant Enterococcus should be paid more attention. Monitoring of antimicrobial resistance of pathogenic bacteria should be strengthened, and antimicrobial agents should be used rationally.