2018年河南省细菌耐药性监测

目的了解河南地区临床分离菌的分布及耐药性。方法对河南省109所医院(34所三级医院中包含2所儿童医院,75所二级医院)临床分离菌采用纸片扩散法和自动化仪器法按统一方案进行细菌药物敏感性试验,按美国临床和实验室标准化协会(CLSI)2018年版标准判断结果。结果收集2018年1-12月上述医院临床分离菌82201株,其中革兰阳性细菌21016株,占25.6%;革兰阴性细菌61185株,占74.4%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRSCN)的检出率分别为36.1%和55.7%,三级医院MRSA和MRSCN的检出率(41.7%和66.9%)均高于二级医院(31.0%和37.8%)。葡萄球菌属未发现对万古霉素耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物(除高浓度庆大霉素外)的耐药率均显著低于屎肠球菌。粪肠球菌和屎肠球菌中均有少数万古霉素、替考拉宁和利奈唑胺耐药株。肠杆菌科细菌(除肺炎克雷伯菌外)对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于13%。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为22.8%和24.2%。三级医院中碳青霉烯类耐药肠杆菌科细菌的检出率(15.0%)高于二级医院(9.4%)。结论河南省临床分离菌对常见抗菌药物的耐药性较高,尤其是碳青霉烯类耐药肺炎克雷伯菌,应进行流行病学调查并进一步采取更加有效的感控措施,控制耐药株的广泛传播。

Surveillance of antibiotic resistance in the bacterial strains isolated from Henan Province in 2018

Objective To investigate the distribution and antibiotic resistance profile of clinical isolates in Henan Province during 2018.Methods Thirty-four tertiary hospitals(including two children’s hospitals),and seventy-five secondary care hospitals were involved in this program.Antimicrobial susceptibility test was carried out according to a unified protocol using Kirby-Bauer method and automated systems.Results were analyzed according to CLSI 2018 breakpoints.Results A total of 82201 clinical isolates were collected from January to December 2018,of which gram positive cocci and gram negative organisms accounted for 25.6%(21016/82201)and 74.4%(61185/82201),respectively.The prevalence of methicillin-resistant isolates was 36.1%in Staphylococcus aureus(MRSA)and 55.7% incoagulase-negative Staphylococcus(MRCNS).The prevalence of MRSA and MRSCN in tertiary hospitals(41.7%,66.9%)was higher than that in secondary hospitals(31.0%,37.8%).All staphylococcal isolates were susceptible to vancomycin.E.faecalis strains showed much lower resistance rates to most of the drugs tested(except high-level gentamicin)than E.faecium.Vancomycin-resistant,teicoplaninresistant and linezolid-resistant Enterococcus was identified in both E.faecalis and E.faecium.The Enterobacteriaceae strains(except K.pneumoniae)were still highly susceptible to carbapenems.Overall,less than 13%of these strains were resistant to carbapenems.About 22.8%and 24.2%of the K.pneumoniae strains were resistant to imipenem and meropenem,respectively.The prevalence of CRE was higher in tertiary hospitals(15.0%)than in secondary hospitals(9.4%).Conclusions The clinical isolates in hospitals across Henan Province show high resistance rates to common antibiotics,especially carbapenem-resistant K.pneumoniae.It is required to strengthen infection control and prevent the spread of antibiotic-resistant strains.