全国细菌耐药监测网2014-2019年腹腔积液标本细菌耐药监测报告

 目的 了解中国腹腔积液标本病原菌分布特点及耐药情况，为临床合理选用抗菌药物提供依据。方法 全部监测数据来源于全国细菌耐药监测网（CARSS）成员单位2014年1月-2019年9月腹腔积液标本中分离获得的菌株，依据保留同一患者相同细菌第一株的原则剔除重复菌株后，纳入最终分析。结果 2014-2019年共检出腹腔积液来源非重复细菌244 744株，每年分离菌株数呈上升趋势。检出居前4位的菌种为大肠埃希菌（32.2%）、肺炎克雷伯菌（9.2%）、屎肠球菌（7.3%）和表皮葡萄球菌（5.8%）。肠杆菌目细菌对头孢他啶、头孢噻肟、左氧氟沙星有较高耐药率，对亚胺培南和阿米卡星耐药率较低，但肺炎克雷伯菌对亚胺培南和阿米卡星的耐药率高于其他肠杆菌目细菌。非发酵菌中铜绿假单胞菌对阿米卡星耐药率较低（为2.3%~5.2%），鲍曼不动杆菌对头孢菌素、碳青霉烯类、喹诺酮类均高度耐药（多数耐药率达50%以上），对米诺环素的耐药率也达14.4%~28.4%。耐甲氧西林金黄色葡萄球菌（MRSA）检出率逐年降低，未发现对利奈唑胺、万古霉素、替考拉宁耐药的菌株。MRSA对所有抗菌药物的耐药率均高于甲氧西林敏感金黄色葡萄球菌（MSSA）。肠球菌属检出最多的是粪肠球菌和屎肠球菌。除利奈唑胺、米诺环素外，粪肠球菌对其他抗菌药物的总体耐药率均低于屎肠球菌。结论 中国腹腔积液来源细菌分布广泛，以大肠埃希菌、肺炎克雷伯菌为代表的革兰阴性杆菌为主，检出率逐年上升；菌株耐药现象较为普遍，但近6年细菌耐药增长趋势较为稳定，个别菌株对特定抗菌药物的耐药率呈逐年下降趋势。大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌等仍需重点监测。临床应根据药敏试验结果合理选用抗菌药物。

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

Objective To understand the distribution characteristics and antimicrobial resistance of pathogenic bacteria from peritoneal effusion specimens in China, and provide evidence for clinical rational selection of antimicrobial agents. Methods All the surveilled data were from strains isolated from peritoneal effusion specimens reported by member hospitals of China Antimicrobial Resistance Surveillance System (CARSS) from January 2014 to September 2019, the first strain of the identical bacteria from the same patient was adopted to be analyzed finally, and repetitive strains were excluded. Results A total of 244 744 strains of non-repetitive bacteria from peritoneal effusion were isolated in 2014-2019, and the number of isolated strains showed an upward trend each year. The top 4 isolated strains were Escherichia coli (32.2%), Klebsiella pneumoniae (9.2%), Enterococcus faecium (7.3%) and Staphylococcus epidermidis (5.8%). Enterobacteriales had higher resistance rates to ceftazidime, cefotaxime and levofloxacin, and lower resistance rates to imipenem and amikacin, but Klebsiella pneumoniae had higher resistance rates to imipenem and amikacin than other Enterobacteriales. Among non-fermentative bacteria, Pseudomonas aeruginosa had low resistance to amikacin (2.3%-5.2%), Acinetobacter baumannii had high resistance to cephalosporins, carbapenems and quinolones (most were >50%), resistance rates to minocycline were 14.4%-28.4%. Isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) decreased year by year, linezolid vancomycin and teicoplanin resistant strain was not found. Resistance rates of MRSA to all antimicrobial agents were all higher than those of methicillin-susceptible Staphylococcus aureus (MSSA). Enterococcus faecalis and Enterococcus faecium were the most common Enterococcus species. Except linezolid and minocycline, the overall resistances rates of Enterococcus faecalis to other antimicrobial agents were all lower than that of Enterococcus faecium. Conclusion Bacteria from peritoneal effusion are widely distributed in China, mainly Gram-negative bacilli such as Escherichia coli and Klebsiella pneumoniae, isolation rate is increasing year by year; antimicrobial resistance strains is common, the growth trend of bacterial resistance in recent 6 years is relatively stable, resistance rate of individual strains to specific antimicrobial agents present a downward trend year by year. Surveillance on some strains such as Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii still need to be strengthened. Rational selection of antimicrobial agents should be based on antimicrobial susceptibility testing results.