湖南省细菌耐药监测网2012—2021年呼吸道分离菌耐药性监测

Antimicrobial resistance of bacteria isolated from respiratory tract, Hunan Province Antimicrobial Resistance Surveillance System, 2012-2021

摘要:

目的 了解2012—2021年湖南省细菌耐药监测网呼吸道分离菌的分布和耐药性变迁。 方法 细菌鉴定和药敏试验统一按全国细菌耐药监测网(CARSS)细菌耐药监测技术方案执行, 剔除重复菌株。按照美国临床实验室标准化协会(CLSI)2022年标准判断细菌对抗菌药物的敏感性, 应用WHONET 5.6软件进行统计描述。 结果 2012—2021年湖南省细菌耐药监测网呼吸道标本共分离976 984株细菌, 其中革兰阳性菌185 642株(19.0%), 革兰阴性菌791 342株(81.0%)。分离自成人患者呼吸道标本排名前五位的细菌是肺炎克雷伯菌(25.2%)、铜绿假单胞菌(17.0%)、鲍曼不动杆菌(14.6%)、大肠埃希菌(6.7%)和金黄色葡萄球菌(5.8%)。分离自儿童患者呼吸道标本排名前五位的细菌是金黄色葡萄球菌(17.7%)、肺炎链球菌(15.6%)、大肠埃希菌(13.5%)、肺炎克雷伯菌(13.1%)和流感嗜血杆菌(10.8%)。肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌对替加环素、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、碳青霉烯类、阿米卡星耐药率较低(< 15%)。肺炎克雷伯菌对亚胺培南、美罗培南的耐药率分别从2012—2013年的3.5%、4.2%逐渐上升至2020—2021年的9.5%、11.5%, 对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星、妥布霉素、环丙沙星和左氧氟沙星的耐药率呈上升趋势。大肠埃希菌和阴沟肠杆菌对氨曲南、氨基糖苷类和氟喹诺酮类的耐药率呈下降趋势。铜绿假单胞菌对多黏菌素耐药率较低(< 6%), 鲍曼不动杆菌对替加环素和多黏菌素耐药率较低(< 6%)。铜绿假单胞菌对β-内酰胺类、氨基糖苷类和氟喹诺酮类耐药率下降。鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率从18.0%上升至43.7%, 对哌拉西林/他唑巴坦、亚胺培南、氟喹诺酮类和米诺环素的耐药率呈上升趋势。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。成人和儿童患者耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为37.8%(14 208/37 594)、22.7%(10 874/47 882)。 结论 湖南省2012—2021年呼吸道分离细菌以革兰阴性菌为主, 成人和儿童患者分离的优势细菌并不相同。大肠埃希菌、阴沟肠杆菌和铜绿假单胞菌对部分抗菌药物的耐药率不断下降。肺炎克雷伯菌对碳青霉烯类耐药率逐渐上升。应持续高效做好细菌耐药监测, 为临床使用抗菌药物提供数据支持。

Abstract:

Objective To investigate the distribution and antimicrobial resistance change of respiratory bacteria isolates from Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021. Methods Bacterial identification and antimicrobial susceptibility testing were performed according to technical scheme of China Antimicrobial Resistance Surveillance System (CARSS), duplicate strains were eliminated. Antimicrobial susceptibility was judged according to the standards from American Clinical and Laboratory Standards Institute (CLSI) 2022, statistical analysis was conducted with WHONET 5.6 software. Results A total of 976 984 bacteria strains isolated from respiratory specimens were collected in Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021. 185 642 strains (19.0%) were Gram-positive and 791 342 (81.0%) were Gram-negative bacteria. The top 5 bacteria isolated from respiratory specimens of adult patients were Klebsiella pneumoniae (25.2%), Pseudomonas aeruginosa (17.0%), Acinetobacter baumannii (14.6%), Escherichia coli (6.7%) and Staphylococcus aureus (5.8%). The top 5 bacteria isolated from respiratory specimens of pediatric patients were Staphylococcus aureus (17.7%), Streptococcus pneumoniae (15.6%), Escherichia coli (13.5%), Klebsiella pneumoniae (13.1%) and Haemophilus influenzae (10.8%). Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae showed lower resistance rates to tigecycline, cefoperazone/sulbactam, piperacillin/tazobactam, carbapenem and amikacin (< 15%). The resistance rates of Klebsiella pneumoniae to imipenem and meropenem increased from 3.5% and 4.2% in 2012-2013 to 9.5% and 11.5% in 2020-2021, respectively, resistance rates to cefoperazone/sulbactam, piperacillin/tazobactam, amikacin, tobramycin, ciprofloxacin and levofloxacin showed an upward trend. Resistance rates of Escherichia coli and Enterobacter cloacae to aztreonam, aminoglycosides, and fluoroquinolones showed a downward trend. Resistance rate of Pseudomonas aeruginosa to polymyxin and resistance rates of Acinetobacter baumannii to tigecycline and polymyxin were all lower (all < 6%). Resistance rates of Pseudomonas aeruginosa to β-lactams, aminoglycosides and fluoroquinolones decreased. Resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam increased from 18.0% to 43.7%, to piperacillin/tazobactam, imipenem, fluoroquinolones and minocycline showed an upward trend. No Staphylococcus aureus strain was found to be resistant to vancomycin, teicolanin and linezolid. Isolation rates of methicillin-resistant Staphylococcus aureus(MRSA) from adult and pediatric patients were 37.8% (14 208/37 594) and 22.7% (10 874/47 882), respectively. Conclusion Gram-negative bacteria was the main bacteria isolated from respiratory specimens in Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021. The predominant bacterial species isolated from adults and pediatric patients were different. The resistance rates of Escherichia coli, Enterobacter cloacae and Pseudomonas aeruginosa to partial antimicrobial agents decreased year by year. The resistance rate of Klebsiella pneumoniae to carbapenems increased gradually. Continuous and efficient surveillance on antimicrobial resistance should be carried out to provide data basis for clinical antimicrobial use.