2011-2016年上海市儿童医院临床分离细菌耐药性监测
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摘要
目的了解上海市儿童医院临床分离菌种类、分布及对常用抗菌药物的耐药性变化。方法采用纸片扩散法进行药敏试验,按照CLSI 2016年标准判读结果,WHONET 5.6软件进行数据分析。结果 2011-2016年共收集非重复菌株23259株,革兰阳性菌10885株(46.8%),革兰阴性菌12374株(53.2%)。甲氧西林耐药的金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)分别占各自菌种的35.8%和82.2%,其中MRSA的检出率由2011年27.4%上升至2016年42.9%。MRSA和MRCNS对绝大多数测试药物的耐药率均显著高于MSSA和MSCNS。肠球菌属中,屎肠球菌对所测试抗菌药物的耐药率显著高于粪肠球菌。非脑膜炎肺炎链球菌中青霉素不敏感肺炎链球菌(PNSP)908株,占31.2%。未发现对万古霉素和利奈唑胺耐药的革兰阳性菌株。革兰阴性菌对碳青霉烯类的耐药率显著上升,其中肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别由2011年的3.1%和4.8%上升至2016年的28.7%和37.4%;铜绿假单胞菌对上述两药的耐药率分别由2011年的13.8%和16.5%上升至2016年的18.8%和19.4%;鲍曼不动杆菌则分别由38.3%和39.9%上升至68.4%和69.7%。结论监测期间儿童患者分离到的MRSA、碳青霉烯类耐药肺炎克雷伯菌、广泛耐药鲍曼不动杆菌检出率仍处于较高水平,对临床抗感染治疗构成严重威胁,需重视儿童临床耐药监测。
Objective To investigate the distribution and resistance profile of bacterial isolates in Shanghai Children's Hospital. Methods Antimicrobial susceptibility of all isolates was determined by Kirby-Bauer disk diffusion method according to 2016 CLSI standard. The data were analyzed by WHONET 5.6 software. Results A total of 23 259 non-duplicate strains were isolated from 2011 to 2016, including 10 885(46.8%) gram-postive cocci and 12 374(53.2%) gram-negative bacilli. The average prevalence of methicillin-resistant S. aureus(MRSA) and coagulase-negative Staphylococcus(MRCNS) was 35.8% and 82.2%, respectively. The prevalence of MRSA rose from 27.4% in 2011 to 42.9% in 2016. The resistance rate of MRSA and MRCNS strains were significantly higher than methicillin sensitive strains. The resistance rate of Enterococcus faecium strains was significant higher than Enterococcus faecalis. The prevalence of non-susceptible Streptococcus pneumoniae was 31.2%(908). No gram-positive strain was resistant to vancomycin or linezolid. The prevalence of carbapenem resistance increased in gram-negative strains. The resistance rate of Klebsiella pneumoniae to imipenem and meropenem rose from 3.1% and 4.8 % in 2011 to 28.7% and 37.4% in 2016, respectively.The rate of Pseudomonas aeruginosa resistance to imipenem and meropenem rose from 13.8% and 16.5% in 2011 to 18.8% and 19.4% in 2016, respectively, while Acinetobacter baumannii showed resistance rate of 38.3% and 39.9 % in 2011 to 68.4% and 69.7% in 2016. Conclusions Increasing prevalence of MRSA, carbapenem-resistant K. pneumoniae, extensively drug-resistant A.baumannii has become a concern in clinical practice. Therefore, antimicrobial resistance surveillance should be highly strengthened in children's hospital.
Objective To investigate the distribution and resistance profile of bacterial isolates in Shanghai Children's Hospital. Methods Antimicrobial susceptibility of all isolates was determined by Kirby-Bauer disk diffusion method according to 2016 CLSI standard. The data were analyzed by WHONET 5.6 software. Results A total of 23 259 non-duplicate strains were isolated from 2011 to 2016, including 10 885(46.8%) gram-postive cocci and 12 374(53.2%) gram-negative bacilli. The average prevalence of methicillin-resistant S. aureus(MRSA) and coagulase-negative Staphylococcus(MRCNS) was 35.8% and 82.2%, respectively. The prevalence of MRSA rose from 27.4% in 2011 to 42.9% in 2016. The resistance rate of MRSA and MRCNS strains were significantly higher than methicillin sensitive strains. The resistance rate of Enterococcus faecium strains was significant higher than Enterococcus faecalis. The prevalence of non-susceptible Streptococcus pneumoniae was 31.2%(908). No gram-positive strain was resistant to vancomycin or linezolid. The prevalence of carbapenem resistance increased in gram-negative strains. The resistance rate of Klebsiella pneumoniae to imipenem and meropenem rose from 3.1% and 4.8 % in 2011 to 28.7% and 37.4% in 2016, respectively.The rate of Pseudomonas aeruginosa resistance to imipenem and meropenem rose from 13.8% and 16.5% in 2011 to 18.8% and 19.4% in 2016, respectively, while Acinetobacter baumannii showed resistance rate of 38.3% and 39.9 % in 2011 to 68.4% and 69.7% in 2016. Conclusions Increasing prevalence of MRSA, carbapenem-resistant K. pneumoniae, extensively drug-resistant A.baumannii has become a concern in clinical practice. Therefore, antimicrobial resistance surveillance should be highly strengthened in children's hospital.
引文
[1]王传清,王爱敏,俞蕙,等.2016年儿童细菌耐药监测[J].中华儿科杂志2018,56(1):29-33.
[2]胡付品.2005-2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[3]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].2016,M100-S26.
[4]FALAGAS M E,KARAGEORGOPOULOS D E.Pandrug resistance(PDR),extensive drug resistance(XDR),and multidrug resistance(MDR)among gram negative bacilli:need for international harmonization in terminology[J].Clin Infect Dis,2008,46(7):1121-1122.
[5]汪复,朱德妹,胡付品,等.2012年中国CHINET细菌性监测[J].中国感染与化疗杂志,2013,13(5):321-330.
[6]胡付品,朱德妹,汪复,等.2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365-374.
[7]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[8]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[9]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[10]徐安,卓超,苏丹虹,等.2005-2014年CHINET克雷伯菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(3):267-274.
[11]TEMKIN E,ADLER A,LEMER A,et al.Carbapenemresistant Enterobacteriaceae:biology,epidemiology,and management[J].Ann N Y Acad Sci,2014,1323:22-42.
[12]MUNOZ-PRICE L S,POIREL L,BONOMO R A,et al.Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases[J].Lancet Infect Dis,2013,13(9):785-796.
[13]ZHU J,SUN L,DING B,et al.Outbreak of NDM-1-producing Klebsiella pneumoniae ST76 and ST37 isolates in neonates[J].Eur J Clin Microbiol Infect Dis,2016,35(4):611-618.
[14]潘芬,刘昌颀,王春,等.儿童感染流感嗜血杆菌的流行病学及耐药机制研究[J].中华医院感染学杂志,2016,26(24):5700-5703.
[15]秦惠宏,王春,潘芬,等.儿童呼吸道分离流感嗜血杆菌的耐药性和基因分型[J].中国感染与化疗杂志,2017,17(5):532-537.
[2]胡付品.2005-2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[3]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].2016,M100-S26.
[4]FALAGAS M E,KARAGEORGOPOULOS D E.Pandrug resistance(PDR),extensive drug resistance(XDR),and multidrug resistance(MDR)among gram negative bacilli:need for international harmonization in terminology[J].Clin Infect Dis,2008,46(7):1121-1122.
[5]汪复,朱德妹,胡付品,等.2012年中国CHINET细菌性监测[J].中国感染与化疗杂志,2013,13(5):321-330.
[6]胡付品,朱德妹,汪复,等.2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365-374.
[7]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[8]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[9]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[10]徐安,卓超,苏丹虹,等.2005-2014年CHINET克雷伯菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(3):267-274.
[11]TEMKIN E,ADLER A,LEMER A,et al.Carbapenemresistant Enterobacteriaceae:biology,epidemiology,and management[J].Ann N Y Acad Sci,2014,1323:22-42.
[12]MUNOZ-PRICE L S,POIREL L,BONOMO R A,et al.Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases[J].Lancet Infect Dis,2013,13(9):785-796.
[13]ZHU J,SUN L,DING B,et al.Outbreak of NDM-1-producing Klebsiella pneumoniae ST76 and ST37 isolates in neonates[J].Eur J Clin Microbiol Infect Dis,2016,35(4):611-618.
[14]潘芬,刘昌颀,王春,等.儿童感染流感嗜血杆菌的流行病学及耐药机制研究[J].中华医院感染学杂志,2016,26(24):5700-5703.
[15]秦惠宏,王春,潘芬,等.儿童呼吸道分离流感嗜血杆菌的耐药性和基因分型[J].中国感染与化疗杂志,2017,17(5):532-537.