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目的总结2005-2014年CHINET呼吸道分离菌的分布及耐药性。方法CHINET成员单位按统一方案、采用统一的材料,药敏试验采用纸片扩散法(K-B法)、自动化仪器法及E试验法,按照美国CLSI 2014年版标准判读结果,用WHONET 5.6软件统计分析呼吸道标本分离菌的分布及耐药性。结果2005-2014年呼吸道标本共分离出229 170株细菌,其中革兰阴性菌占78.8%,革兰阳性菌占18.4%。常见细菌依次为鲍曼不动杆菌(16.7%)、铜绿假单胞菌(16.5%)、肺炎克雷伯菌(14.8%)、金黄色葡萄球菌(金葡菌)(11.8%)、大肠埃希菌(7.1%)、嗜麦芽窄食单胞菌(5.8%)、阴沟肠杆菌(3.8%)、肺炎链球菌(3.7%)、流感嗜血杆菌(3.1%)等。药敏结果显示,儿童患者中肺炎链球菌青霉素耐药和中介菌株(PRSP、PISP)检出率分别为16.1%、23.5%,明显高于成人患者(3.3%、5.9%),儿童患者中PRSP发生率明显增加,从2006年5.4%上升至2013年21.9%;β溶血链球菌对青霉素和头孢菌素类高度敏感,肺炎链球菌和A群链球菌对红霉素、克林霉素耐药率>80%,对氟喹诺酮类、万古霉素、利奈唑胺仍保持较高敏感率。流感嗜血杆菌成人株与儿童株中β内酰胺酶检出率分别为22.7%与36.5%,对阿奇霉素、头孢呋辛、左氧氟沙星敏感率>90%。金葡菌中未检出万古霉素、替考拉宁、利奈唑胺耐药株,甲氧西林耐药金葡菌(MRSA)检出率为60.8%。大肠埃希菌对碳青霉烯类最敏感(耐药率<3%),其次为头孢哌酮-舒巴坦、哌拉西林-他唑巴坦(耐药率<10%)。肺炎克雷伯菌对亚胺培南、美罗培南耐药率逐年增高,分别从2005年3.1%、2.5%上升至2014年10.3%、14.2%,亚胺培南耐药肺炎克雷伯菌仅对替加环素耐药率较低为12.8%。鲍曼不动杆菌对米诺环素、头孢哌酮-舒巴坦、亚胺培南、美罗培南耐药率逐年增加,对替加环素耐药率较低为6.7%。铜绿假单胞菌对主要抗菌药物耐药率逐年降低,对阿米卡星、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、头孢吡肟、头孢他啶、环丙沙星、庆大霉素耐药率<30%。结论呼吸道病原菌仍以革兰阴性杆菌为主,细菌耐药现象严重,临床应重视病原菌的监测并结合药敏试验结果合理使用抗菌药物。
Objective To summarize the distribution and drug resistance of CHINET respiratory isolates from 2005 to 2014. Methods CHINET member units according to a unified program, using a uniform material, drug susceptibility testing using disk diffusion method (KB method), automated instrumentation and E test method, according to the US CLSI 2014 version of the standard interpretation of the results, using WHONET 5.6 software statistical analysis of the respiratory tract Distribution and Drug Resistance of Specimen Isolates. Results A total of 229 170 strains of bacteria were isolated from respiratory specimens in 2005-2014, of which Gram-negative bacteria accounted for 78.8% and Gram-positive bacteria accounted for 18.4%. The common bacteria were Acinetobacter baumannii (16.7%), Pseudomonas aeruginosa (16.5%), Klebsiella pneumoniae (14.8%), Staphylococcus aureus (11.8%), (7.1%), Stenotrophomonas maltophilia (5.8%), Enterobacter cloacae (3.8%), Streptococcus pneumoniae (3.7%) and Haemophilus influenzae (3.1%). The susceptibility results showed that the detection rates of penicillin-resistant and PRSP (PISP) of Streptococcus pneumoniae in children were 16.1% and 23.5%, respectively, which were significantly higher than those in adult patients (3.3% and 5.9% The incidence increased significantly from 5.4% in 2006 to 21.9% in 2013. β-hemolytic streptococcus was highly sensitive to penicillins and cephalosporins. Streptococcus pneumoniae and group A streptococci were resistant to erythromycin and clindamycin Rate> 80%, fluoroquinolones, vancomycin, linezolid still maintain a high sensitivity. The detection rate of β-lactamase in both Haemophilus influenzae strains and children was 22.7% and 36.5% respectively, and the sensitivity rate to azithromycin, cefuroxime and levofloxacin was> 90%. The detection rates of vancomycin, teicoplanin, linezolid-resistant strains and methicillin-resistant Staphylococcus aureus (MRSA) in S. aureus were 60.8%. Escherichia coli was the most susceptible to carbapenems (resistance rate <3%), followed by cefoperazone-sulbactam and piperacillin-tazobactam (resistance rate <10%). Klebsiella pneumoniae resistance to imipenem and meropenem increased year by year, from 3.1% in 2005 and 2.5% in 2014 to 10.3% in 2014 and 14.2% in 2014, respectively. Imipenem-resistant Klebsiella pneumoniae The resistance rate to tigecycline was 12.8% lower. Acinetobacter baumannii resistance to minocycline, cefoperazone - sulbactam, imipenem, meropenem increased year by year, the lower the rate of resistance to tigecycline was 6.7%. The resistance rate of Pseudomonas aeruginosa to major antimicrobial agents was decreasing year by year. The rates of resistance to amikacin, piperacillin-tazobactam, cefoperazone-sulbactam, cefepime, ceftazidime, ciprofloxacin, Tajimycin resistance rate <30%. Conclusions Gram-negative bacilli are still the main pathogens of respiratory tract infection, and the bacterial resistance is serious. Clinical should pay attention to the monitoring of pathogenic bacteria and use antibacterial drugs reasonably in combination with the results of drug susceptibility test.