全国细菌耐药监测网2021年肾内科患者分离细菌耐药监测报告

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

摘要:

目的 了解全国肾内科住院患者常见病原菌分布及耐药性。 方法 对2021年全国细菌耐药监测网(CARSS)成员单位上报的所有肾内科住院患者分离菌及其耐药性进行分析。 结果 肾内科住院患者共分离细菌122 203株, 主要来源于尿、痰及血标本, 占比分别为49.2%、16.7%和13.4%, 其中, 革兰阴性菌共81 994株(67.1%), 革兰阳性菌共40 209株(32.9%)。最常见的前5位病原菌分别为大肠埃希菌(39 914株, 32.7%)、肺炎克雷伯菌(12 695株, 10.4%)、金黄色葡萄球菌(11 977株, 9.8%)、铜绿假单胞菌(6 583株, 5.4%) 及屎肠球菌(5 821株, 4.8%)。头孢曲松耐药的大肠埃希菌、肺炎克雷伯菌检出率分别为47.2%(15 704/33 272)、30.7%(3 091/10 070);耐碳青霉烯类的大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌检出率分别为1.0%(388/38 813)、8.2%(1 000/12 206)和4.8%(135/2 813)。鲍曼不动杆菌对亚胺培南、美罗培南、多黏菌素和替加环素的耐药率分别为27.6%(972/3 523)、29.6%(813/2 748)、1.3%(8/625)和2.2%(38/1 730);铜绿假单胞菌对亚胺培南、美罗培南和多黏菌素的耐药率分别为10.1%(640/6 335)、8.4%(477/5 678)和1.2%(11/955)。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)检出率分别为23.3%(2 787/11 977)和68.5%(7 290/10 644), 未检测到对万古霉素耐药的葡萄球菌。屎肠球菌、粪肠球菌对万古霉素的耐药率分别为1.1%(65/5 740)、0.1%(7/4 738)。 结论 肾内科住院患者分离的革兰阴性菌以大肠埃希菌和肺炎克雷伯菌为主, 革兰阳性菌以金黄色葡萄球菌为主。革兰阴性菌对碳青霉烯类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢他啶/阿维巴坦耐药率较低, 革兰阳性菌对万古霉素、替考拉宁、利奈唑胺耐药率较低。临床应根据肾内科患者的药敏结果及疾病特点, 合理选用抗菌药物。

Abstract:

Objective To understand the distribution and antimicrobial resistance of frequently isolated pathogenic bacteria from hospitalized patients in nephrology department in China. Methods All isolated pathogenic bacteria from hospitalized patients in nephrology department reported by member units of China Antimicrobial Resistance Surveillance System (CARSS) in 2021 and their antimicrobial resistance were analyzed. Results A total of 122 203 bacterial strains were isolated from hospitalized patients in nephrology department, mainly from urine, sputum and blood, accounting for 49.2%, 16.7% and 13.4%, respectively. 81 994 strains (67.1%) were Gram-negative bacteria and 40 209 strains (32.9%) were Gram-positive bacteria. The top 5 frequently isolated pathogens were Escherichia coli (39 914, 32.7%), Klebsiella pneumoniae (12 695, 10.4%), Staphylococcus aureus (11 977, 9.8%), Pseudomonas aeruginosa (6 583, 5.4%) and Enterococcus faecium (5 821, 4.8%). The detection rate of ceftria-xone-resistant Escherichia coli and Klebsiella pneumoniae were 47.2% (15 704/33 272) and 30.7% (3 091/10 070), respectively. The detection rates of carbapenem-resistant Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae were 1.0% (388/38 813), 8.2% (1 000/12 206) and 4.8% (135/2 813), respectively. The resistance rates of Acinetobacter baumannii to imipenem, meropenem, polymyxin and tigecycline were 27.6% (972/3 523), 29.6% (813/2 748), 1.3% (8/625) and 2.2% (38/1 730), respectively. The resistance rates of Pseudomonas aeruginosa to imipenem, meropenem and polymyxin were 10.1% (640/6 335), 8.4% (477/5 678) and 1.2% (11/955), respectively. The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcs (MRCNS) were 23.3% (2 787/11 977) and 68.5% (7 290/10 644), respectively. No vancomycin-resistant Staphylococcus was detected. The resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 1.1% (65/5 740) and 0.1% (7/4 738), respectively. Conclusion Gram-negative bacteria isolated from hospitalized patients in nephrology department are mainly Escherichia coli and Klebsiella pneumoniae, and Gram-positive bacteria are mainly Staphylococcus aureus. The resistance rates of Gram-ne-gative bacteria to carbapenems, piperacillin/tazobactam, cefoperazone/sulbactam, and ceftazidime/avibactam are low, and the resistance rates of Gram-positive bacteria to vancomycin, teicoplanin, and linezolid are low. Antimicrobial agents should be selected rationally according to antimicrobial susceptibility testing results and disease features of patients in nephrology department.