刘文静;徐英春;杨启文;王瑶;孙宏莉;赵颖;窦红涛;刘亚丽;郭莉娜;朱任媛;张丽;肖盟;张小江;
LIU Wen-jing;XU Ying-chun;YANG Qi-wen;WANG Yao;SUN Hong-li;ZHAO Ying;DOU Hong-tao;LIU Ya-li;GUO Li-na;ZHU Ren-yuan;ZHANG Li;XIAO Meng;ZHANG Xiao-jiang;Department of Clinical Laboratory,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院检验科北京市侵袭性真菌病机制研究与精准诊断重点实验室

摘要(Abstract)：

目的了解2019年北京协和医院分离的常见细菌对抗菌药物的耐药性。方法回顾性分析2019年1月1日至12月31日从北京协和医院分离的11 404株非重复细菌的药敏结果。结果 11 404株细菌中革兰氏阴性菌占63.8%(7276/11 404)、革兰氏阳性菌占36.2%(4128/11 404)。葡萄球菌属中,甲氧西林耐药的金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)和甲氧西林耐药的凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus, MRCNS)的检出率分别为18.9%(191/1009)和77.3%(659/853),两者对红霉素的耐药率均较高(79.6%、83.2%)。肠球菌属中,屎肠球菌和粪肠球菌的检出率别为38.2%(437/1143)和54.6%(624/1143),对利奈唑胺(0.2%、0.3%)、万古霉素(4.3%、0.2%)和替考拉宁(3.0%、0)的耐药率较低。链球菌属中,肺炎链球菌、α溶血链球菌、A群和B群β溶血链球菌的检出率分别为12.8%(130/1012)、37.9%(384/1012)、4.2%(43/1012)和39.0%(395/1012),各菌种对红霉素、阿奇霉素和克林霉素的耐药率较高,其中肺炎链球菌和A群β溶血链球菌对此3种抗菌药物的耐药率均≥88.7%。肠杆菌科中,碳青霉烯类耐药肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae, CRE)、肺炎克雷伯菌广泛耐药(extensive drug resistance, XDR)菌株的检出率分别为7.1%(308/4324)、4.7%(60/1273);肠杆菌科细菌对替加环素、碳青霉烯类和阿米卡星的耐药率较低。不发酵糖革兰氏阴性杆菌中,鲍曼不动杆菌对替加环素的耐药率最低(6.9%),对哌拉西林的耐药率最高(93.3%);铜绿假单胞菌对阿米卡星的耐药率最低(4.5%),对左氧氟沙星的的耐药率最高(22.6%);鲍曼不动杆菌和铜绿假单胞菌中XDR菌株的检出率为12.3%(117/949)和1.8%(21/1137)。流感嗜血杆菌中,β-内酰胺酶的阳性率为34.1%(45/132);流感嗜血杆菌对氨苄西林的耐药率最高(62.9%),除氯霉素外对其他抗菌药物的耐药率为33.3%～48.4%。结论 2019年北京协和医院分离的常见细菌对常用抗菌药物有不同程度的耐药,可能对抗菌药物的合理使用和科学管理有指导作用。
Objective To investigate the antimicrobial resistance of clinical bacterial isolates in PekingUnion Medical College Hospital(PUMCH) in 2019. Methods The antimicrobial resistance of 11 404 non-duplicated common bacteria isolated from PUMCH during January 1 to December 31, 2019 were retrospectively analyzed. Results In the totally 11 404 clinical isolates, Gram-negative bacilli and gram-positive cocci accounted for 63.8%(7276/11 404) and 36.2%(4128/11 404), respectively. Methicillin-resistant Staphylococcus aureus(MRSA) and Methicillin-resistant coagulase-negative Staphylococcus(MRCNS) accounted for 18.9%(191/1009) and 77.3%(659/853), respectively, both of which had a high resistance rate to erythromycin(79.6%, 83.2%). Enterococcus faecium and Enterococcus faecalis accounted for 38.2%(437/1143) and 54.6%(624/1143) in Enterococci, respectively; and the resistance rates to linezolid(0.2%, 0.3%), vancomycin(4.3%, 0.2%) and teicoplanin(3.0%, 0) were low. The detection rates of Streptococcus pneumoniae, α-hemolytic Streptococcus, group A and group B β-hemolytic Streptococcus were 12.8%(130/1012), 37.9%(384/1012), 4.2%(43/1012) and 39.0%(395/1012) in Streptococcus, respectively. The resistance rates of all strains to erythromycin, azithromycin and clindamycin were more than 88.7% in Streptococcus pneumoniae and group β-hemolytic Streptococcus. Among the Enterobacteriaceae, the detection rates of carbapenem resistant Enterobacteriaceae(CRE) and extensive drug resistance(XDR) strains in Klebsiella pneumoniae were 7.1%(308/4324) and 4.7%(60/1273), respectively. The resistance rates of Enterobacteriaceae to tigecycline, carbapenems and amikacin were low. Among the non-fermentative Gram negative bacilli, Acinetobacter baumannii had the lowest resistance rate to tigecycline(6.9%) and the highest resistance rate to piperacillin(93.3%); Pseudomonas aeruginosa had the lowest resistance rate to amikacin(4.5%) and the highest resistance rate to levofloxacin(22.6%). The detection rates of XDR strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 12.3%(117/949) and 1.8%(21/1137), repectively. Among Haemophilus influenzae, the positive rate of β-lactamase was 34.1%(45/132); the resistance rate to ampicillin was the highest(62.9%); the resistance rate to other antibiotics except chloramphenicol were 33.3%-48.4%. Conclusions The common bacteria isolated from PUMCH in 2019 have different degrees of resistance to commonly used antibiotics, which may play a guiding role in the rational use and scientific management of antibiotics.

关键词(KeyWords)： 药敏试验;细菌耐药性监测;抗菌药物
antimicrobial susceptibility test;antimicrobial resistance surveillances;antimicrobial agents

Abstract:

Keywords:

基金项目(Foundation): 国家十三五科技重大专项(2019ZX09721-001-006-004-003);; 北京市临床重点专科医学检验科卓越项目(ZK201000)~~

作者(Authors): 刘文静;徐英春;杨启文;王瑶;孙宏莉;赵颖;窦红涛;刘亚丽;郭莉娜;朱任媛;张丽;肖盟;张小江;
LIU Wen-jing;XU Ying-chun;YANG Qi-wen;WANG Yao;SUN Hong-li;ZHAO Ying;DOU Hong-tao;LIU Ya-li;GUO Li-na;ZHU Ren-yuan;ZHANG Li;XIAO Meng;ZHANG Xiao-jiang;Department of Clinical Laboratory,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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