2019年上海市三级医院细菌耐药监测

目的监测上海地区2019年三级甲等医院临床分离菌对抗菌药物的耐药性。方法对上述医院临床分离菌采用纸片扩散法或自动化仪器法,按上海市细菌真菌耐药监测网技术方案进行抗菌药物敏感性试验。按2019年CLSI文件标准判断结果。结果收集2019年1-12月监测网内三级医院临床分离菌共119 318株,其中革兰阳性菌占29.1%(34 756/119 318),革兰阴性菌占70.9%(84 562/119 318)。金黄色葡萄球菌、表皮葡萄球菌和其他凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA、MRSE和其他MRCNS)的检出率分别为43.4%、83.2%和76.6%。甲氧西林耐药株(MRSA、MRSE和其他MRCNS)对绝大多数抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA、MSSE和其他MSCNS)。MRSA对甲氧苄啶-磺胺甲[口恶]唑和利福平的耐药率低,分别为5.2%和3.0%,MRSE对利福平耐药率低(7.6%),未发现万古霉素和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠球菌;粪肠球菌中未发现万古霉素耐药株,但对利奈唑胺耐药率达1.7%;屎肠球菌对万古霉素和利奈唑胺耐药率分别为0.4%和0.2%。2019年儿童和成人中分离的肺炎链球菌中青霉素敏感株(PSSP)分别占96.8%和96.9%,检出率较2018年有所上升,中介和耐药株(PISP和PRSP)的检出率则有所下降。肠杆菌目细菌对碳青霉烯类抗生素仍较敏感,多数菌属的耐药率低于20.0%(除克雷伯菌属外)。此外,不动杆菌属对亚胺培南和美罗培南的耐药率分别为63.4%和63.1%,铜绿假单胞菌对上述两药的耐药率分别为30.0%和26.1%。结论临床分离菌对常见抗菌药物的耐药性仍呈增长趋势,尤其是碳青霉烯类耐药革兰阴性杆菌。上海市三级医院的耐药形势仍然严峻,需各相关部门协作以遏制耐药细菌流行播散。

Surveillance of bacterial resistance in tertiary hospitals across Shanghai in 2019

Objective To investigate the susceptibility and resistance of clinical isolates collected from tertiary care hospitals in Shanghai during 2019.Methods The clinical strains were collected from tertiary hospitals across Shanghai.Antimicrobial susceptibility testing was carried out according to a unified protocol of Shanghai Antimicrobial Resistance Surveillance Network using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2019 breakpoints.Results A total of 119318 clinical isolates were collected from January to December 2019,of which gram negative bacteria and gram positive cocci accounted for 70.9%(84562/119318)and 29.1% (34756/119318),respectively.The prevalence of methicillin-resistant strains was 43.4%in S.aureus(MRSA),83.2%in S epidermidis(MRSE),and 76.6% in other coagulase-negative Staphylococcus(MRCNS).MR(MRSA,MRSE and other MRCNS)strains showed much higher resistance rates to most of the antimicrobial agents than MS(MSSA,MSSE,and other MSCNS)strains.However,5.2% and 3.0% of the MRSA strains were resistant to trimethoprim-sulfamethoxazole and rifampin,7.6% of the MRSE strains were resistant to rifampin.No staphylococcal strains were found resistant to vancomycin or linezolid.E.faecalis strains demonstrated much lower resistance rates to most of the drugs tested than E.faecium.No vancomycinresistant strain was found in E.faecalis,but 1.7% of the E.faecalis strains were resistant to linezolid.About 0.4% and 0.2% of the E.faecium strains were resistant to vancomycin and linezolid,respectively.The S.pneumoniae strains isolated from children and adults in 2019 showed higher prevalence of PSSP(96.8% and 96.9%)than in 2018,while the prevalence of PISP and PRSP in 2019 was lower than that in 2018.The strains of Enterobacterales were still susceptible to carbapenems.Overall,less than 20.0% of these strains were resistant to carbapenems(except Klebsiella spp.).In addition,about 63.4% and 63.1% of the Acinetobacter strains were resistant to imipenem and meropenem,respectively.About 30.0% and 26.1% of the P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions Bacterial resistance to commonly used antibiotics is still on the rise,especially carbapenem-resistant gram-negative bacilli.It is necessary to strengthen the collaboration among different departments to contain the bacterial resistance.