湖南省细菌耐药监测网2012—2021年细菌耐药性监测报告

Antimicrobial resistance of bacteria: surveillance report from Hunan Provincial Antimicrobial Resistance Surveillance System, 2012-2021

摘要:

目的 了解2012—2021年湖南省临床标本常见病原菌分布及其耐药性变迁情况，为临床合理使用抗菌药物及制定和评价抗菌药物临床应用管理政策提供科学依据。 方法 细菌鉴定方法、质控菌株选择及测试抗菌药物种类参照全国细菌耐药监测网（CARSS）技术方案执行，依据每例患者统计第一株菌的原则，剔除重复菌株。应用WHONET 5.6软件进行统计分析，线性趋势检验分析菌株构成比及耐药率的变迁情况，Pearson相关系数描述变化率的大小。 结果 2012—2021年，纳入分析的临床分离细菌由82 759株增加至312 914株，以革兰阴性菌为主，占比69.5%~72.4%。革兰阳性菌以金黄色葡萄球菌、表皮葡萄球菌、肺炎链球菌、粪肠球菌和屎肠球菌为主，革兰阴性菌以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和阴沟肠杆菌为主。革兰阳性菌分离率逐年上升（r=0.022，P=0.001）。耐甲氧西林金黄色葡萄球菌（MRSA）的临床分离率由34.3%下降至24.8%。耐万古霉素屎肠球菌和粪肠球菌的分离率分别低于3%、2%，且呈下降趋势。耐青霉素肺炎链球菌（PRSP）检出率由最高5.6%下降至1.0%。大肠埃希菌对所检测抗菌药物的耐药率除头孢哌酮/舒巴坦外均呈下降趋势（r < 0，P=0.001）。对第三代头孢菌素耐药大肠埃希菌（CTX/CRO-R-EC）和耐碳青霉烯类大肠埃希菌（CREC）分离率逐年下降（分别由70.5%降至45.3%，12.2%降至2.0%）。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率逐年增加，2021年分别上升至9.1%、11.0%。耐碳青霉烯类铜绿假单胞菌（CRPA）的分离率由28.5%逐年下降至15.0%。鲍曼不动杆菌对大多数抗菌药物耐药率为40%~60%，且相对稳定。耐碳青霉烯类鲍曼不动杆菌（CRAB）的分离率为39.5%~59.6%。 结论 大部分重要特殊耐药菌临床分离率均逐年下降，肺炎克雷伯菌对碳青霉烯类药物的耐药率逐渐增加。未来应持续做好临床抗菌药物合理应用和特殊耐药菌医院感染防控，继续提高湖南省细菌耐药监测的质量。

Abstract:

Objective To understand the distribution of frequently isolated pathogenic bacteria from clinical specimens and their antimicrobial resistance changes in Hunan Province from 2012 to 2021, and to provide scientific evidence for the formulation and evaluation of antimicrobial clinical administration policies. Methods Species identification, selection of quality control strains and antimicrobial susceptibility testing agents were conducted according to the technical scheme of the China Antimicrobial Resistance Surveillance System (CARSS). Duplicate strains were excluded based on the principle of counting the first strain in each case. Statistical analysis was performed by WHONET 5.6 software. The the variations in constituent ratio and resistance rate of strains were analyzed with linear trend test, and the magnitude of change was described with Pearson correlation coefficient. Results From 2012 to 2021, the number of clinically isolated bacteria in the analysis increased from 82 759 to 312 914, with Gram-negative bacteria accounting for 69.5%-72.4%. The major Gram-positive bacteria were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Enterococcus faecalis and Enterococcus faecium, and the major Gram-negative bacteria were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae. Isolation rate of Gram-positive bacteria increased yearly (r=0.022, P=0.001). Isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) decreased from 34.3% to 24.8%. Isolation rates of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis were less than 3% and 2%, respectively, presenting a downward trend. The detection rate of penicillin-resistant Streptococcus pneumoniae (PRSP) decreased from 5.6% to 1.0%. Except cefoperazone sulbactam, resistance rates of Escherichia coli to other tested antimicrobial agents showed decreasing trends (r < 0, P=0.001). Isolation rates of third-generation cephalosporin-resistant Escherichia coli (CTX/CRO-R-EC) and carbapenem-resistant Escherichia coli (CREC) decreased year by year (from 70.5% to 45.3%, and 12.2% to 2.0%, respectively). Resistance rates of Klebsiella pneumo-niae to imipenem and meropenem have increased year by year, reaching 9.1% and 11.0% respectively in 2021, while isolation rate of carbapenem-resistant Pseudomonas aeruginosa (CRPA) decreased from 28.5% to 15.0%. Resistance rates of Acinetobacter baumannii to most antimicrobial agents were 40%-60%, and remained relatively stable. Isolation rate of carbapenem-resistant Acinetobacter baumannii (CRAB) ranged from 39.5% to 59.6%. Conclusion The clinical isolation rates of most important special antimicrobial-resistant bacteria have been decreasing year by year, while the resistance rate of Klebsiella pneumoniae to carbapenem agents gradually increased. Antimicrobial stewardship as well as the prevention and control of healthcare-associated infection on specific antimicrobial-resistant bacteria should continue to be implemented in the future. The coverage and quality of antimicrobial resistance surveillance in Hunan Province should continue to be improved.