我国2017-2023年新德里金属β-内酰胺酶阳性耐药菌流行现状分析
Analysis of the prevalence of New Delhi metallo-β-lactamase-positive drug-resistant bacteria in China from 2017 to 2023
李可馨 1肖杨 2陈明亮 3王盛书 4王博千 5彭芷溪 1梁胜男 6任洪广 5宋宏彬 6胡晓丰6
作者信息
- 1. 中国医科大学,沈阳 110122;解放军疾病预防控制中心,北京 100071
- 2. 重庆大学医学院,重庆 400030
- 3. 陆军军医大学军事预防医学系,重庆 400038
- 4. 解放军总医院第二医学中心,北京 100853
- 5. 军事科学院军事医学研究院,北京 100071
- 6. 解放军疾病预防控制中心,北京 100071
- 折叠
摘要
目的 综合分析我国新德里金属β-内酰胺酶(NDM)阳性耐药菌的流行病学特征及耐药机制.方法 在中国知网和PubMed数据库中检索国内发现NDM阳性耐药菌的相关文献(发表时间为2017年1月1日至2023年12月31日),对NDM阳性耐药菌菌株种类与地区分布、感染来源、耐药率和转移机制进行流行病学分析.结果 共筛选符合条件的文献118篇,报道NDM阳性耐药菌1627株,2011-2019年,报道数量逐年递增,2020年开始逐年下降;NDM-1与NDM-5阳性菌数量居多;地区分布以华东地区报道数量最多,其次为华中、华北地区;NDM阳性耐药菌主要为肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌;NDM阳性耐药菌感染患者年龄特征较为明显,新生儿与儿童、50岁以上的患者分别占27.25％和49.57％.NDM阳性耐药菌主要来源于痰(38.28％)、尿(28.94％)和血液(23.28％);科室来源主要为ICU(39.93％)、儿科(20.14％);NDM阳性耐药菌对绝大多数抗生素耐药性超过50.00％,仅对黏菌素、替加环素等耐药性差(低于30.00％);携带blaNDM基因的质粒型主要为IncX3,且blaNDM基因上下游存在的插入序列呈多样性.结论 NDM阳性耐药菌在我国多个地区广泛流行,且表现出多重耐药,给临床抗生素的选择带来较大困难和挑战,亟待提出有效应对措施.
Abstract
Objective To comprehensively analyze the epidemiological characteristics and resistance mechanisms of New Delhi metallo-β-lactamase(NDM)-positive multidrug-resistant bacteria in China.Methods Relevant literatures on NDM-positive multidrug-resistant bacteria discovered in China were searched in the CNKI and PubMed databases(publications from January 1,2017 to December 31,2023).The epidemiological analysis was conducted on the types of NDM-positive bacterial strains,their regional distribution,infection sources,resistance profiles,and transfer mechanisms.Results A total of 118 eligible articles were collected,reporting 1627 NDM-positive bacterial strains.The number of reports increased annually from 2011 to 2019,but began to decline annually from 2020 onwards.NDM-1 and NDM-5 were the most commonly reported variants.The highest number of reports came from Eastern China,followed by Central China and North China.The primary pathogens were Klebsiella pneumoniae,Escherichia coli,and Enterobacter cloacae.The age distribution of patients with NDM-positive infections showed distinct patterns,with neonates and children accounting for 27.25％and patients over 50 years old accounting for 49.57％.The majority of positive bacterial infections came from sputum(38.28％),urine(28.94％),and blood(23.28％).The main departments reporting NDM-positive bacteria were the ICU(39.93％)and pediatrics(20.14％).These resistant bacteria exhibited resistance to more than 50.00％of antibiotics,with lower resistance to colistin and tigecycline(below 30.00％).The predominant plasmid type carrying the blaNDMwas IncX3,and the insertion sequences upstream and downstream of the blaNDM showed diversity.Conclusion NDM-positive multidrug-resistant bacteria are widely prevalent across regions in China,exhibiting multidrug-resistance.This poses significant challenges to clinical antibiotic selection and necessitates the development of effective countermeasures.
关键词
新德里金属β-内酰胺酶/流行特征/耐药谱Key words
New Delhi metallo-β-lactamase/epidemiological characteristics/resistance profile引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据