湖南省细菌耐药监测网2012—2021年尿标本分离细菌耐药监测报告

Antimicrobial resistance of bacteria isolated from urine specimens: surveillance report from Hunan Province Antimicrobial Resistance Surveillance System, 2012-2021

摘要:

目的 了解湖南省临床尿标本细菌分布及耐药情况, 为尿路感染患者的抗感染治疗提供科学依据。 方法 按照全国细菌耐药监测网技术方案要求开展细菌耐药监测工作, 参考美国临床实验室标准化协会标准判断药敏试验结果, 应用WHONET 5.6软件分析2012—2021年湖南省细菌耐药监测网成员单位上报的尿标本分离细菌的菌株资料及耐药性数据。 结果 2012—2021年尿标本检出细菌379 330株, 其中革兰阴性菌占75.3% (72.4%~76.0%), 革兰阳性菌占24.7%(24.0%~27.6%)。革兰阴性菌中居前5位的细菌分别为大肠埃希菌(48.3%)、肺炎克雷伯菌(8.4%)、奇异变形杆菌(3.3%)、铜绿假单胞菌(3.0%)、阴沟肠杆菌(1.6%)。革兰阳性菌中居前5位的细菌分别为屎肠球菌(8.1%)、粪肠球菌(6.6%)、表皮葡萄球菌(1.9%)、金黄色葡萄球菌(1.9%)、溶血葡萄球菌(1.4%)。不同性别及不同年龄段患者尿标本检出细菌构成不同, 居首位的大肠埃希菌在男性、女性中分别占34.8%、57.2%, 在成人和儿童中分别占49.0%、34.4%。大肠埃希菌对碳青霉烯类抗生素、阿米卡星、替加环素、头孢哌酮/舒巴坦、呋喃妥因保持较高的敏感性, 耐药率＜10%;对头孢唑林、头孢呋辛、头孢曲松、头孢噻肟、喹诺酮类抗菌药物的耐药性较高, 耐药率＞48%;对头孢他啶、头孢曲松、头孢噻肟、头孢吡肟、氨曲南的耐药率呈下降趋势(均P＜0.001)。肺炎克雷伯菌对碳青霉烯类抗生素、阿米卡星、替加环素保持较高的敏感性, 耐药率＜11%, 对喹诺酮类抗菌药物耐药率远低于大肠埃希菌。屎肠球菌、粪肠球菌对万古霉素、替考拉宁、利奈唑胺均保持较高的敏感性, 耐药率均＜5%;粪肠球菌对氨苄西林、呋喃妥因的耐药率＜15%;除利奈唑胺和米诺环素外, 屎肠球菌对被检测抗菌药物的耐药率均高于粪肠球菌。未检出对万古霉素、利奈唑胺、替考拉宁耐药的金黄色葡萄球菌。 结论 湖南省细菌耐药监测网各成员单位尿标本检出细菌以大肠埃希菌为主, 在早期经验性治疗的同时, 临床应尽快根据细菌鉴定和药敏结果进行目标用药, 从而提高治疗效果和减缓耐药产生。

Abstract:

Objective To understand the distribution and antimicrobial resistance of bacteria from clinical urine specimens in Hunan Province, and provide scientific basis for anti-infection treatment of patients with urinary tract infection (UTI). Methods Bacterial resistance surveillance was carried out according to the technical scheme requirements of China Antimicrobial Resistance Surveillance System, antimicrobial susceptibility testing results were judged based on standard of American Clinical and Laboratory Standards Institute, data about strains and antimicrobial resistance of bacteria from urine specimens reported by member units of Hunan Province Antimicrobial Resistance Surveillance System in 2012-2021 were analyzed with WHONET 5.6 software. Results A total of 379 330 strains of bacteria were isolated from urine specimens in 2012-2021, Gram-negative and Gram-positive bacteria accounted for 75.3% (72.4%-76.0%) and 24.7% (24.0%-27.6%), respectively. The top 5 Gram-negative bacteria were Escherichia coli (48.3%), Klebsiella pneumoniae (8.4%), Proteus mirabilis (3.3%), Pseudomonas aeruginosa (3.0%) and Enterobacter cloacae (1.6%). The top 5 Gram-positive bacteria were Enterococcus faecium (8.1%), Enterococcus faecalis (6.6%), Staphylococcus epidermidis (1.9%), Staphylococcus aureus (1.9%) and Staphylococcus haemolyticus (1.4%). The constituent of bacteria isolated from urine specimens of patients in different gender and age groups were different. Escherichia coli ranked first, accounting for 34.8% and 57.2% in males and females, respectively, as well as 49.0% and 34.4% in adults and children, respectively. Escherichia coli maintained high susceptibility to carbapenems, amikacin, tigecycline, cefoperazone/sulbactam and furantoin, with resistance rate < 10%, while resistance to cefazolin, cefuroxime, ceftriaxone, cefotaxime and quinolones were relatively higher, with resistance rate >48%; resistance rates to ceftazidime, ceftriaxone, cefotaxime, cefepime and aztreonam presented decreased trend (all P < 0.001). Klebsiella pneumoniae maintained higher susceptibility to carbapenems, amikacin and tigecycline, with resistance rate < 11%, resistance rate to quinolones was much lower than that of Escherichia coli. Enterococcus faecium and Enterococcus faecalis maintained high susceptibility to vancomycin, teicoplanin and linezolid, with resistance rates < 5%; resistance rate of Enterococcus faecalis to ampicillin and furantoin was < 15%. Except for linezolid and minocycline, resistance rates of Enterococcus faecium to the other tested antimicrobial agents were all higher than Enterococcus faecalis. No Staphylococcus aureus was found to be resistant to vancomycin, linezolid and teicoplanin. Conclusion Escherichia coli is the main bacteria isolated from urine specimens from various member units of Hunan Province Antimicrobial Resistance Surveillance System. In early empirical treatment, clinical antimicrobial should be targetedly used as early as possible based on bacterial identification and antimicrobial susceptibility testing results, so as to improve treatment effectiveness and slow down the emergence of antimicrobial resistance.