2005—2017年中国CHINET常见革兰阴性菌对碳青霉烯类抗生素耐药的监测结果
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摘要
目的:从中国CHINET多年监测结果分析常见革兰阴性菌对碳青霉烯类抗生素耐药情况,为临床使用碳青霉烯类药物提供流行病学依据。方法:登陆http://www.chinets.com,收集2005—2017年中国CHINET细菌耐药性监测数据结果,对常见细菌数量进行构成比的趋势分析。结果:临床标本分离菌中革兰阴性菌(65.7%～72.6%)已经明显超过革兰阳性菌(27.0%～34.3%),其中革兰阴性菌主要为肠杆菌科细菌和不发酵糖细菌,革兰阳性菌主要为葡萄球菌属细菌和肠球菌属细菌。除铜绿假单胞菌外,革兰阴性菌对美罗培南和亚胺培南耐药率呈逐年增加。肠杆菌属细菌与不发酵糖细菌对碳青霉烯类药物耐药率比较,后者明显高于前者,其中鲍曼不动杆菌耐药率及增长率均居于首位,铜绿假单胞菌耐药率次之。结论:中国常见革兰阴性菌对碳青霉烯类抗生素耐药已经明显突出,尤其是鲍曼不动杆菌全国耐药率已经呈现爆发流行。
Objective:To analyze the surveillance of carbapenem-resistant gram-negative bacteria from the data of China CHINET and provide an epidemiological basis for clinical use of carbapenems.Method:We visited the website of http://www.chinets.com and collected the monitoring data of China CHINET from 2005 to 2017.We analyzed the proportions of common bacteria.Result:Gram-negative bacteria(65.7%-72.6%,mainly including Enterobacteriaceae and Non-fermentative bacteria)significantly exceeded gram-positive bacteria(27.0%-34.3%,mainly including Staphylococcus and Enterococcus)in the isolated bacteria of clinical specimens.Except Pseudomonas aeruginosa,the resistance rate to meropenem and imipenem have increased year by year in gram-negative bacteria.Compared with Non-fermentable bacteria,Enterobacteriaceae have higher carbapenem-resistant rate,and the resistant and growth rate of Acinetobacter baumannii taken the first place,which was followed by Pseudomonas aeruginosa.Conclusion:The carbapenem-resistant gram-negative bacteria has been obviously prominent in China,especially Acinetobacter baumannii has been in a nationwide outbreak.
Objective:To analyze the surveillance of carbapenem-resistant gram-negative bacteria from the data of China CHINET and provide an epidemiological basis for clinical use of carbapenems.Method:We visited the website of http://www.chinets.com and collected the monitoring data of China CHINET from 2005 to 2017.We analyzed the proportions of common bacteria.Result:Gram-negative bacteria(65.7%-72.6%,mainly including Enterobacteriaceae and Non-fermentative bacteria)significantly exceeded gram-positive bacteria(27.0%-34.3%,mainly including Staphylococcus and Enterococcus)in the isolated bacteria of clinical specimens.Except Pseudomonas aeruginosa,the resistance rate to meropenem and imipenem have increased year by year in gram-negative bacteria.Compared with Non-fermentable bacteria,Enterobacteriaceae have higher carbapenem-resistant rate,and the resistant and growth rate of Acinetobacter baumannii taken the first place,which was followed by Pseudomonas aeruginosa.Conclusion:The carbapenem-resistant gram-negative bacteria has been obviously prominent in China,especially Acinetobacter baumannii has been in a nationwide outbreak.
引文
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[8] Codjoe FS,Donkor ES.Carbapenem Resistance:A Review[J].Med Sci(Basel),2017,6(1):E1.
[9]Kotsanas D,Wijesooriya WR,Korman TM,et al.“Down the drain”:carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks[J].Med J Aust,2013,198(5):267-269.
[10]Bulens SN,Yi SH,Walters MS,et al.CarbapenemNonsusceptible Acinetobacter baumannii,8 US Metropolitan Areas,2012-2015[J].Emerg Infect Dis,2018,24(4):727-734.
[11]Gupta N,Limbago BM,Patel JB,et al.CarbapenemResistant Enterobacteriaceae:Epidemiology and Prevention[J].Clin Infect Dis,2011,53(1):60-67.
[12]Gutiérrez O,Juan C,Cercenado E,et al.Molecular Epidemiology and Mechanisms of Carbapenem Resistance in Pseudomonas aeruginosa Isolates from Spanish Hospitals[J].Antimicrob Agents Chemother,2007,51(12):4329-4335.
[13]Poirel L,Nordmann P.Carbapenem resistance in Acinetobacter baumannii:mechanisms and epidemiology[J].Clin Microbiol Infect,2006,12(9):826-836.
[14]Leavitt A,Chmelnitsky I,Ofek I,et al.Plasmid pKpQIL encoding KPC-3and TEM-1confers carbapenem resistance in an extremely drug-resistant epidemic Klebsiella pneumoniae strain[J].J Antimicrob Chemother,2010,65(2):243-248.
[2] Prestinaci F,Pezzotti P,Pantosti A.Antimicrobial resistance:aglobal multifaceted phenomenon[J].Pathog Glob Health,2015,109(7):309-318.
[3] Amaratunga K,Tarasuk J,Tsegaye L,et al.Advancing surveillance of antimicrobial resistance:Summary of the 2015CIDSC Report[J].Can Commun Dis Rep,2016,42(11):232-237.
[4] Organization WH.Antimicrobial Resistance:Global Report on Surveillance[J].Australasian Med J,2014,7(4):237.
[5] International C.Antibiotic resistance threats in the United States,2013[EB/OL].Centers for Disease Control and Prevention.US Department of Health and Human Services(2013).https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=51.
[6]李理,白颖,周宁.ICU病房常见致病菌细菌分布及耐药分析[J].临床急诊杂志,2018,19(4):240-245.
[7]曾宪炳,刘军,钟如柱.鲍曼不动杆菌临床流行病学特点及耐亚胺培南鲍曼不动杆菌感染的危险因素研究[J].临床急诊杂志,2018,19(1):1-5.
[8] Codjoe FS,Donkor ES.Carbapenem Resistance:A Review[J].Med Sci(Basel),2017,6(1):E1.
[9]Kotsanas D,Wijesooriya WR,Korman TM,et al.“Down the drain”:carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks[J].Med J Aust,2013,198(5):267-269.
[10]Bulens SN,Yi SH,Walters MS,et al.CarbapenemNonsusceptible Acinetobacter baumannii,8 US Metropolitan Areas,2012-2015[J].Emerg Infect Dis,2018,24(4):727-734.
[11]Gupta N,Limbago BM,Patel JB,et al.CarbapenemResistant Enterobacteriaceae:Epidemiology and Prevention[J].Clin Infect Dis,2011,53(1):60-67.
[12]Gutiérrez O,Juan C,Cercenado E,et al.Molecular Epidemiology and Mechanisms of Carbapenem Resistance in Pseudomonas aeruginosa Isolates from Spanish Hospitals[J].Antimicrob Agents Chemother,2007,51(12):4329-4335.
[13]Poirel L,Nordmann P.Carbapenem resistance in Acinetobacter baumannii:mechanisms and epidemiology[J].Clin Microbiol Infect,2006,12(9):826-836.
[14]Leavitt A,Chmelnitsky I,Ofek I,et al.Plasmid pKpQIL encoding KPC-3and TEM-1confers carbapenem resistance in an extremely drug-resistant epidemic Klebsiella pneumoniae strain[J].J Antimicrob Chemother,2010,65(2):243-248.