全国细菌耐药监测网2014-2019年粪便标本细菌耐药监测报告

 目的 了解全国粪便标本分离病原菌的菌群分布及耐药情况。方法 从2014-2019年全国细菌耐药监测网报告中提取粪便标本的相关数据（去除肠道正常定植菌群），分析肠道致病菌及其耐药率的变迁。结果 共分离菌株61 809株，居前3位的是沙门菌属（82.12%）、志贺菌属（8.08%）、弧菌属（4.03%），沙门菌属在每年粪便标本致病菌中占绝对优势，均在70%以上，以2018年占比最高（87.16%）。6年间居前6位的致病菌菌种无变化，仅菌种构成比每年略有变化，沙门菌属呈上升趋势，志贺菌属呈下降趋势。各菌属分别以未分型沙门菌（49.39%）、福氏志贺菌（46.64%），副溶血弧菌（91.20%）、嗜水气单胞菌（55.80%）、肠致病性大肠埃希菌（85.02%）为主。肠道致病菌对氨苄西林耐药率均较高，其中志贺菌属和致腹泻性大肠埃希菌（>90%）高于沙门菌属和弧菌属。沙门菌对左氧氟沙星耐药率较低，但呈上升趋势，由低于3%上升至10%左右；志贺菌属对环丙沙星耐药率2016年较低（29.9%）；除氨苄西林外，弧菌属对其他抗菌药物耐药率均较低（<6%）；气单胞菌属出现了耐碳青霉烯类菌株，气单胞菌属和致腹泻性大肠埃希菌对阿米卡星耐药率较低。结论 细菌性腹泻的病原菌种类较多，以沙门菌属和志贺菌属为主，耐药情况较为严重，且不同菌属、菌种之间差异较大，应继续加强抗菌药物合理应用的管理及医院感染防控，做好耐药菌监测工作。

Antimicrobial resistance of bacteria from fecal specimens:surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from fecal specimens in China. Methods Relevant data of fecal specimens (excluding intestinal normal colonized bacteria) were extracted from surveillance report of China Antimicrobial Resistance Surveillance System (CARSS) in 2014-2019, changes of intestinal pathogenic bacteria and antimicrobial resistance rates in the past 6 years were analyzed. Results A total of 61 809 strains were isolated, the top 3 were Salmonella spp. (82.12%), Shigella spp. (8.08%) and Vibrio spp. (4.03%), Salmonella spp. accounted for more than 70% of pathogenic bacteria in fecal specimens each year, with the highest proportion of 87.16% in 2018. In the past 6 years, there was no change in the top 6 pathogenic bacteria strains, only constituent ratios of bacterial species changed slightly each year, Salmonella spp. showed an upward trend, while Shigella spp. showed a downward trend. The major bacteria were unclassified species of Salmonella (49.39%), Shigella flexneri (46.64%), Vibrio parahaemolyticus (91.20%), Aeromonas hydrophila (55.80%) and enteropathogenic Escherichia coli (85.02%). Resistance rate of enteropathogenic bacteria to ampicillin was high, Shigella spp. and diarrheagenic Escherichia coli (>90%) were higher than Salmonella spp. and Vibrio spp. Resistance rate of Salmonella to levofloxacin was low, but show a rising trend, which increased from less than 3% to about 10%; resistance rate of Shigella spp. to ciprofloxacin was low (29.9%) in 2016; resistance rates of Vibrio spp. to antimicrobial agents (except ampicillin) were low (<6%); carbapenem-resistant Aeromonas spp. strains emerged, resistance rates of Aeromonas spp. and diarrheagenic Escherichia coli to amikacin were both low. Conclusion There are multiple species of pathogenic bacteria causing bacterial diarrhea, mainly Salmonella spp. and Shigella spp., antimicrobial resistance is serious, different bacterial species and strains vary significantly, it is necessary to continue to strengthen the management of rational application of antimicrobial agents as well as prevention and control of healthcare -associated infection, and do a good job in the surveillance of antimicrobial-resistant bacteria.