全国细菌耐药监测网2018—2021年中医医院多重耐药菌监测报告

Multidrug-resistant organisms in traditional Chinese medicine hospitals: surveillance report from China Antimicrobial Resistance Surveillance System, 2018-2021

摘要:

目的 了解全国中医医院临床标本常见多重耐药菌分布及变化趋势, 为临床抗菌药物合理应用提供科学依据。 方法 收集2018—2021年全国中医医院临床分离的常见细菌体外药敏数据。其中, 体外药敏试验方法包括纸片扩散法、自动化仪器法和E-test法等, 按照美国临床实验室标准化协会(CLSI)标准判读药敏结果。按照全国细菌耐药监测网(CARSS)技术方案, 应用WHONET 5.6软件对菌种分布和多重耐药菌检出情况及变化趋势进行分析。 结果 2018—2021年临床分离菌株中, 革兰阳性菌占比26.4%~27.4%, 革兰阴性菌占比72.6%~73.6%, 趋势稳定。革兰阳性菌中, 耐甲氧西林金黄色葡萄球菌(MRSA)检出率呈上升趋势, 从28.5%上升至30.2%, 但耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、耐万古霉素屎肠球菌、耐青霉素肺炎链球菌检出率均呈下降趋势, 分别从2018年的76.1%、2.7%、3.1%, 下降至72.4%、1.5%、1.8%。革兰阴性菌中, 耐碳青霉烯类大肠埃希菌和耐碳青霉烯类肺炎克雷伯菌的检出率逐渐上升, 分别从1.6%、10.4%上升至1.9%、13.3%, 但耐碳青霉烯类铜绿假单胞菌和耐碳青霉烯类鲍曼不动杆菌的检出率均呈下降趋势, 分别从22.4%、49.5%下降至21.9%、48.2%。此外, 多重耐药菌的检出存在明显地区差异, MRSA在安徽省、江苏省和广东省检出率最高, 在云南省、黑龙江省和吉林省检出率最低。同时, 耐碳青霉烯类肺炎克雷伯菌在安徽省、上海市和河南省检出率最高, 在宁夏、青海省和吉林省检出率最低。 结论 MRSA、耐碳青霉烯类肺炎克雷伯菌、耐碳青霉烯类大肠埃希菌检出率呈上升趋势, 其他临床常见多重耐药菌的检出率呈下降趋势或持平, 多重耐药菌的检出率存在时间及地域性差异。应继续加强抗菌药物合理应用的管理及医院感染防控, 做好细菌耐药监测工作。

Abstract:

Objective To understand the distribution and changing trend of multidrug-resistant organisms (MDROs) from clinical specimens in traditional Chinese medicine hospitals, provide scientific basis for rational clinical antimicrobial use. Methods In vitro antimicrobial susceptibility testing data of frequently clinically isolated bacteria from traditional Chinese medicine hospitals nationwide from 2018 to 2021 were collected. In vitro antimicrobial susceptibility testing methods included disk diffusion method, automated apparatus method, and E-test method. Antimicrobial susceptibility testing results were interpreted according to the American Clinical and Laboratory Standards Institute (CLSI) standards. According to the technical program of China Antimicrobial Resistance Surveillance System (CARSS), the distribution of bacterial species as well as the detection and changing trend of MDROs were analyzed with WHONET 5.6 software. Results Among clinical isolates from 2018 to 2021, Gram-positive and Gram-negative bacteria accounted for 26.4%-27.4% and 72.6%-73.6%, respectively, with a stable trend. Among Gram-positive bacteria, isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) increased from 28.5% to 30.2%, however, methicillin-resistant coagulase negative Staphylococcus (MRCNS), vancomycin-resistant Enterococcus faecium and penicillin-resistant Streptococcus pneumoniae (PRSP) all showed decreasing trends, from 76.1%, 2.7% and 3.1% in 2018 to 72.4%, 1.5% and 1.8%, respectively. Among Gram-negative bacteria, isolation rates of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae gradually increased from 1.6% and 10.4% to 1.9% and 13.3%, respectively. However, isolation rates of carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii showed downward trends, decreasing from 22.4% and 49.5% to 21.9% and 48.2%, respectively. In addition, detection of MDROs varied significantly in different regions. Isolation rates of MRSA were highest in Anhui, Jiangsu, and Guangdong Provinces, but lowest in Yunnan, Heilongjiang, and Jilin Provinces. Meanwhile, isolation rates of carbapenem-resistant Klebsiella pneumoniae were highest in Anhui Province, Shanghai City, and Henan Province, but lowest in Ningxia, Qinghai and Jilin Provinces. Conclusion The isolation rates of MRSA, carbapenem-resistant Klebsiella pneumoniae, and carbapenem-resistant Escherichia coli show increasing trends, while isolation rates of other clinically isolated MDROs present downward trends or remain unchanged. There are temporal and regional differences in the isolation rate of MDROs. Management of rational use of antimicrobial agents as well as healthcare-associated infection prevention and control should continue to be strengthened, bacterial antimicrobial resistance monitoring should be conducted well.