2016年中国14家教学医院革兰阴性杆菌耐药监测分析

摘要

Objective To investigate antimicrobial resistance among nosocomial gram-negative bacilli in 2016 across China.Methods About 1 394 consecutive and non-repetitive gram-negative bacilli were isolated from 14 teaching hospitals from March to August in 2016 across China.All of these isolates were sent to the central laboratory for reidentification and susceptibility testing.The minimal inhibitory concentration(MICs)of meropenem and other antibacterial agents were determined by agar dilution method.The data were analyzed by using WHONET-5.6 software.Results The activity of antimicrobial agents against Enterobacteriaceae was as follows in descending order of susceptible rate: meropenem (95.2%,891/936), amikacin (94.6%,885/936), ertapenem (92.1%,862/936), piperacillin/tazobactam (88.1%,825/936), imipenem (88.0%,823/936), cefoperazone-sulbactam (83.1%,778/936), cefepime (72.2%,676/936), cefiazidime (72.2%,676/936), levofloxacin(68.8%,644/936), ciprofloxacin (63.2%,592/936), minocyline (62.9%,589/936), cefiriaxone (54.9%,514/936), cefotaxime (54.0%,505/936), cefoxitin (44.3%,415/936).The sensitivities of E.coli to carbapenems, amikacin, piperacillin-tazobactam, polymyxin B and cefoperazone-sulbactam were over 80%.The more sensitive antibiotic to Klebsiella pneumoniae was polymyxin B (99.0%), followed by amikacin (84.9%), meropenem (84.4%) and imipenem (82.0%).The prevalence of extended-spectrum β-lactamase was 62.8%(137/218)in Escherichia coli and 28.3%(58/205)in Klebsiella pneumonia.The activity of antimicrobial agents against E.cloacae, E.aerogenes and Citrobacter freundii was as follows in descending order of susceptible rate: meropenem (97.0%-98.5%), amikacin (95.8%-98.3%), imipenem (94.5%-97.5%), polymyxin B (96.4%-100%), cefoperazone-sulbactam (76.5%-90.0%), ertapenem (73.3%-90.1%), piperacillin/tazobactam (82.4%-88.3%).The most active agents against Pseudomonas aeruginosa were polymyxinB (100%), followed by amikacin (89.3%) and ciprofloxacin (82.4%).The most active agents against Acinetobacter baumannii were polymyxinB (100%).The sensitivities of Acinetobacter baumannii to meropenem, imipenem, minocycline and cefoperazone-sulbactam were 20.3%(39/202), 19.3%(41/202), 66.3%(134/202) and 24.8%(50/202), respectively.Conclusions Carbapenems remain high sensitive against Enterobacteriaceae.Controlling carbapenem resistant Klebsiella pneumoniae is urgent.Drug antimicrobial resistance in A.baumanni is a still serious problem.%目的 监测2016年中国革兰阴性杆菌的耐药性.方法 回顾性研究.收集2016年3至8月全国14家教学医院的1 394株非重复革兰阴性杆菌.菌株经中心实验室复核后,采用琼脂稀释法测定美罗培南等15种药物的最低抑菌浓度.药敏结果判断采用CLSI 2016年M100S(第26版)标准.数据分析采用WHONET-5.6软件.结果 全部抗菌药物对936株肠杆菌科细菌的抗菌活性,敏感率依次为美罗培南(95.2%,891/936)、阿米卡星(94.6%,885/936)、厄他培南(92.1%,862/936)、哌拉西林/他唑巴坦(88.1%,825/936)、亚胺培南(88.0%,823/936)、头孢哌酮/舒巴坦(83.1%,778/936)、头孢吡肟(72.2%,676/936)、头孢他啶(72.2%,676/936)、左氧氟沙星(68.8%,644/936)、环丙沙星(63.2%,592/936)、米诺环素(62.9%,589/936)、头孢曲松(54.9%,514/936)、头孢噻肟(54.0%,505/936)和头孢西丁(44.3%,415/936).对于大肠埃希菌,敏感性在80%以上的药物除碳青霉烯类之外,还有多黏菌素B(97.2%,212/218)、阿米卡星(96.3%,210/220)、哌拉西林/他唑巴坦(92.7%,202/218)和头孢哌酮/舒巴坦(81.7%,178/218).肺炎克雷伯菌对多黏菌素B的敏感率最高(99.0%,203/205),其次为阿米卡星(84.9%,174/205)、美罗培南(84.4%,173/205)和亚胺培南(82.0%,168/205).产超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌发生率分别为62.8%(137/218)和28.3%(58/205).对阴沟肠杆菌、产气肠杆菌和弗劳地柠檬酸菌,抗菌活性最高的药物依次为美罗培南(97.0%~98.5%)、阿米卡星(95.8%~98.3%)、亚胺培南(94.5%~97.5%)、多黏菌素B(96.4%~100%)、头孢哌酮/舒巴坦(76.5%~90.0%)、厄他培南(73.3%~90.1%)和哌拉西林/他唑巴坦(82.4%~88.3%).奇异变形杆菌、普通变形杆菌和摩根摩根菌对美罗培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的敏感率均大于90%.铜绿假单胞菌对多黏菌素B敏感率最高为100%,其次为阿米卡星(89.3%,183/205)和环丙沙星(82.4%,169/205).鲍曼不动杆菌对多黏菌素B的敏感率最高,为100%(205/205).对亚胺培南和美罗培南的敏感率分别为19.3%(39/202)和20.3%(41/202),对米诺环素敏感率为66.3%(134/202),对头孢哌酮/舒巴坦敏感率为24.8%(50/202).结论 碳青霉烯类对肠杆菌科细菌仍保持较高的抗菌活性.碳青霉烯耐药的肺炎克雷伯菌亟需得到控制,我国鲍曼不动杆菌耐药问题严重.