湖南省细菌耐药监测网2012—2021年血标本分离细菌耐药性监测报告

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

摘要:

目的 了解湖南省血标本分离细菌的分布及耐药性变迁,为临床血流感染初始经验诊治提供依据。方法 收集湖南省细菌耐药监测网2012—2021年各成员单位上报数据,细菌耐药监测方法参照全国细菌耐药监测网(CARSS)技术方案执行, 应用WHONET 5.6软件和SPSS 27.0软件对血标本分离细菌及药敏试验结果进行分析。结果 2012—2021年湖南省细菌耐药监测网成员单位血标本共分离细菌207 054株,其中革兰阳性菌107 135株 (51.7%)、革兰阴性菌99 919株(48.3%);2012—2021年居前6位的病原菌无变化,居首位的为大肠埃希菌(51 537株,24.9%),其次分别为表皮葡萄球菌(29 115株,14.1%)、金黄色葡萄球菌(17 402株,8.4%)、肺炎克雷伯菌(17 325株,8.4%)、铜绿假单胞菌(4 010株,1.9%)和鲍曼不动杆菌(3 598株,1.7%)。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率由2015年的30.3%下降至2021年的20.7%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率呈逐年上升趋势(57.9%~66.8%)。未发现对万古霉素、利奈唑胺和替考拉宁耐药的葡萄球菌。革兰阴性菌中,大肠埃希菌、肺炎克雷伯菌构成比分别为43.9%~53.9%、14.2%~19.5%,呈上升趋势(均P＜0.001); 铜绿假单胞菌、鲍曼不动杆菌的构成比分别为3.6%~5.1%、3.0%~4.5%,呈逐年下降趋势(均P＜0.001)。2012—2021年大肠埃希菌对亚胺培南、厄他培南的耐药率分别为1.0%~2.0%、0.6%~1.1%,呈下降趋势(均P＜0.001)。肺炎克雷伯菌对美罗培南、厄他培南的耐药率分别为7.4%~13.7%、4.8%~6.4%,呈下降趋势(均P＜0.001)。铜绿假单胞菌、鲍曼不动杆菌对碳青霉烯类抗生素的耐药率分别为7.1%~15.6%、34.7%~45.7%, 对碳青霉烯类抗生素的耐药性趋势相对稳定,但与2012—2016年相比均有下降。2012—2021年大肠埃希菌对第三代头孢菌素的耐药率为41.0%~65.4%,呈逐年下降趋势。结论 湖南省血标本革兰阴性杆菌构成比逐年增高,耐碳青霉烯类革兰阴性杆菌的检出率近5年相对稳定,凝固酶阴性葡萄球菌检出率呈下降趋势。

Abstract:

Objective To understand the change in distribution and antimicrobial resistance of bacteria isolated from blood specimens of Hunan Province, and provide for the initial diagnosis and treatment of clinical bloodstream infection (BSI). Methods Data reported from member units of Hunan Province Antimicrobial Resistance Survei-llance System from 2012 to 2021 were collected. Bacterial antimicrobial resistance surveillance method was implemented according to the technical scheme of China Antimicrobial Resistance Surveillance System (CARSS). Bacteria from blood specimens and bacterial antimicrobial susceptibility testing results were analyzed by WHONET 5.6 software and SPSS 27.0 software. Results A total of 207 054 bacterial strains were isolated from blood specimens from member units in Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021, including 107 135 (51.7%) Gram-positive bacteria and 99 919 (48.3%) Gram-negative bacteria. There was no change in the top 6 pathogenic bacteria from 2012 to 2021, with Escherichia coli (n=51 537, 24.9%) ranking first, followed by Staphylococcus epidermidis (n=29 115, 14.1%), Staphylococcus aureus (n=17 402, 8.4%), Klebsiella pneumoniae (17 325, 8.4%), Pseudomonas aeruginosa (n=4 010, 1.9%) and Acinetobacter baumannii (n=3 598, 1.7%). The detection rate of methicillin-resistant Staphylococcus aureus (MRSA) decreased from 30.3% in 2015 to 20.7% in 2021, while the detection rate of methicillin-resistant coagulase-negative Staphylococcus (MRCNS) showed an upward trend year by year (57.9%-66.8%). No Staphylococcus was found to be resistant to vancomycin, linezolid, and teicoplanin. Among Gram-negative bacteria, constituent ratios of Escherichia coli and Klebsiella pneumoniae were 43.9%-53.9% and 14.2%-19.5%, respectively, both showing an upward trend (both P<0.001). Constituent ratios of Pseudomonas aeruginosa and Acinetobacter baumannii were 3.6%-5.1% and 3.0%-4.5%, respectively, both showing a downward trend year by year (both P<0.001). From 2012 to 2021, resistance rates of Escherichia coli to imipenem and ertapenem were 1.0%-2.0% and 0.6%-1.1%, respectively; presenting a downward trend (P＜0.001). The resistant rates of Klebsiella pneumoniae to meropenem and ertapenem were 7.4%-13.7% and 4.8%-6.4%, respectively, presenting a downward trend (both P<0.001). The resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenem antibiotics were 7.1%-15.6% and 34.7%-45.7%, respectively. The trend of resistance to carbapenem antibiotics was relatively stable, but has decreased compared with 2012-2016. The resistance rates of Escherichia coli to the third-generation cephalosporins from 2012 to 2021 were 41.0%-65.4%, showing a downward trend year by year. Conclusion The constituent ratio of Gram-negative bacillus from blood specimens in Hunan Province has been increasing year by year, while the detection rate of carbapenem-resistant Gram-negative bacillus remained relatively stable in the past 5 years, and the detection rate of coagulase-negative Staphylococcus has shown a downward trend.