全国细菌耐药监测网2021年泌尿外科患者分离细菌耐药监测报告

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

摘要:

目的 了解2021年全国泌尿外科患者分离细菌菌种分布及耐药情况。 方法 按照全国细菌耐药监测网(CARSS)技术方案, 应用WHONET 5.6软件对2021年所有CARSS成员单位上报的泌尿外科患者分离细菌及药敏试验结果数据进行分析。 结果 泌尿外科患者共分离菌株232 603株, 其中革兰阴性菌166 483株(71.6%), 革兰阳性菌66 120株(28.4%)。标本构成中排名前5位的分别为尿、血、伤口分泌物、痰和腹腔积液。分离细菌中革兰阴性菌排名前5位的分别为大肠埃希菌(57.5%)、肺炎克雷伯菌(10.8%)、铜绿假单胞菌(5.8%)、奇异变形杆菌(5.3%)和阴沟肠杆菌(3.4%); 分离细菌中革兰阳性菌排名前5位的分别为粪肠球菌(36.2%)、屎肠球菌(14.9%)、表皮葡萄球菌(10.5%)、无乳链球菌(9.5%)和金黄色葡萄球菌(7.3%)。未发现对万古霉素、替考拉宁和利奈唑胺耐药的金黄色葡萄球菌, 耐甲氧西林金黄色葡萄球菌对庆大霉素、利福平、左氧氟沙星、复方磺胺甲口恶唑、克林霉素和红霉素的耐药率均高于甲氧西林敏感金黄色葡萄球菌。大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌对亚胺培南(1.1%~5.3%)、美罗培南(0.7%~5.9%)和厄他培南(0.7%~4.4%)的耐药率较低, 对头孢曲松的耐药率为36.5%~54.5%;肠杆菌目中除奇异变形杆菌对多黏菌素B天然耐药外, 其他菌对替加环素、多黏菌素B、头孢他啶/阿维巴坦耐药率均较低。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南、美罗培南、多黏菌素B、替加环素、头孢他啶/阿维巴坦及加酶抑制剂药物的耐药率较低。 结论 泌尿外科标本构成比中以尿标本为主, 分离菌株以肠杆菌目大肠埃希菌、肺炎克雷伯菌等为主, 且肠杆菌目细菌耐药率也有所不同, 进行尿标本细菌耐药监测可为尿路感染抗菌药物合理应用提供参考数据。

Abstract:

Objective To understand the distribution and antimicrobial resistance of bacteria isolated from patients in department of urology in China in 2021. Methods According to the technical program of China Antimicrobial Resistance Surveillance System (CARSS), data and antimicrobial susceptibility testing results of bacteria isolated from patients in department of urology reported by all CARSS member units in 2021were analyzed with WHONET 5.6 software. Results A total of 232 603 strains of bacteria were isolated from urological patients, 166 483 (71.6%) were Gram-negative bacteria and 66 120 (28.4%) were Gram-positive bacteria. The top 5 specimens were urine, blood, wound secretion, sputum, and abdominal peritoneal effusion. The top 5 isolated Gram-negative bacteria were Escherichia coli(57.5%), Klebsiella pneumoniae(10.8%), Pseudomonas aeruginosa(5.8%), Proteus mirabilis(5.3%), and Enterobacter cloacae(3.4%). The top 5 isolated Gram-positive bacteria were Enterococcus faecalis(36.2%), Enterococcus faecium(14.9%), Staphylococcus epidermidis(10.5%), Streptococcus lactis(9.5%), and Staphylococcus aureus(7.3%). Vancomycin-, teicoplanin-, and linezolid-resistant Staphylococcus aureus was not found. The resistance rates of methicillin-resistant Staphylococcus aureus to gentamicin, rifampicin, levofloxacin, cotrimoxazole, clindamycin, and erythromycin were all higher than those of methicillin-sensitive Staphylococcus aureus. The resistance rates of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis to imipenem(1.1%-5.3%), meropenem(0.7%-5.9%), and ertapenem (0.7%-4.4%) were relatively low, and the resistance rates to ceftriaxone ranged from 36.5% to 54.5%. Resistance rates of Enterobacterales to tegacyclin, polymyxin B, and ceftazidime/avibactam were relatively low. Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem, meropenem, polymyxin B, tegacyclin, ceftazidime/avibactam, and enzyme inhibitor agents were relatively low. Conclusion The major specimen from department of urology is urine, the main isolated pathogenic bacteria are Escherichia coli and Klebsiella pneumoniae, and antimicrobial resistance rate of Enterobacterales is different. Surveillance on the antimicrobial resistance of bacteria isolated from urine specimens can provide reference for the rational use of antimicrobial agents in urinary tract infection.