摘要
目的 了解2015-2021年中国不同地区临床分离葡萄球菌属细菌的分布及耐药变迁.方法 按CHINET中国细菌耐药监测网统一的技术方案对临床分离的葡萄球菌采用纸片法和商品化药敏试验测试仪(机器法)进行药物敏感性试验;收集2015-2021年CHINET的葡萄球菌耐药监测数据,使用WHONET 5.6软件统计并按2021年CLSI折点标准判读结果.结果 2015-2021年共分离非重复葡萄球菌属细菌204 771株,其中金黄色葡萄球菌136 731株(66.8％),凝固酶阴性葡萄球菌68 040株(33.2％),7年间两者检出率均无明显变化.金黄色葡萄球菌主要分离自呼吸道标本(38.9±5.1)％、伤口脓液分泌物(33.6±4.2)％、血液(11.9±1.5)％;凝固酶阴性葡萄球菌主要分离自血液(73.6±4.2)％、脑脊液(12.1±2.5)％、胸腹水(8.4±2.1)％.金黄色葡萄球菌的科室来源主要为ICU(17.0±7.3)％、门急诊(11.6±1.7)％、外科(11.2±0.9)％;凝固酶阴性葡萄球菌的科室来源主要为ICU(32.2±9.7)％、门急诊(12.8±4.7)％、内科(11.2±1.9)％.金黄色葡萄球菌、凝固酶阴性葡萄球菌中甲氧西林耐药株的总体检出率分别为32.9％、74.1％,7年间MRSA检出率从42.1％下降至29.2％,MRCNS检出率从82.1％下降至68.2％.除甲氧苄啶-磺胺甲(噁)唑外,MRSA对各类抗菌药物的耐药率均高于MSSA.MRSA对庆大霉素、利福平、左氧氟沙星耐药率有所下降;MRCNS对庆大霉素、红霉素、利福平、甲氧苄啶-磺胺甲嗯唑的耐药率有所下降,对左氧氟沙星的耐药率有所上升.未发现对万古霉素耐药的葡萄球菌菌株.对利奈唑胺耐药的MRCNS有所增多,7年间耐药率从0.2％上升至2.3％.结论 葡萄球菌属细菌仍是革兰阳性菌中最主要的细菌.MRSA和MRCNS亦仍然是革兰阳性菌中最主要的耐药细菌.至今未发现对万古霉素和利奈唑胺耐药的金黄色葡萄球菌,但已有利奈唑胺耐药的MRCNS菌株检出,应加强监测和关注.
Abstract
Objective To investigate the changing distribution and antibiotic resistance profiles of clinical isolates of Staphylococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Staphylococcus according to the unified protocol of CHINET(China Antimicrobial Surveillance Network)using disk diffusion method and commercial automated systems.The CHINET antimicrobial resistance surveillance data from 2015 to 2021 were interpreted according to the 2021 CLSI breakpoints and analyzed using WHONET 5.6.Results During the period from 2015 to 2021,a total of 204,771 nonduplicate strains of Staphylococcus were isolated,including 136,731(66.8％)strains of Staphylococcus aureus and 68,040(33.2％)strains of coagulase-negative Staphylococcus(CNS).The proportions of S.aureus isolates and CNS isolates did not show significant change.S.aureus strains were mainly isolated from respiratory specimens(38.9±5.1)％,wound,pus and secretions(33.6±4.2)％,and blood(11.9±1.5)％.The CNS strains were predominantly isolated from blood(73.6±4.2)％,cerebrospinal fluid(12.1±2.5)％,and pleural effusion and ascites(8.4±2.1)％.S.aureus strains were mainly isolated from the patients in ICU(17.0±7.3)％,outpatient and emergency(11.6±1.7)％,and department of surgery(11.2±0.9)％,whereas CNS strains were primarily isolated from the patients in ICU(32.2±9.7)％,outpatient and emergency(12.8±4.7)％,and department of internal medicine(11.2±1.9)％.The prevalence of methicillin-resistant strains was 32.9％in S.aureus(MRSA)and 74.1％in CNS(MRCNS).Over the 7-year period,the prevalence of MRSA decreased from 42.1％to 29.2％,and the prevalence of MRCNS decreased from 82.1％to 68.2％.MRSA showed higher resistance rates to all the antimicrobial agents tested except trimethoprim-sulfamethoxazole than methicillin-susceptible S.aureus(MSSA).Over the 7-year period,MRSA strains showed decreasing resistance rates to gentamicin,rifampicin,and levofloxacin,MRCNS showed decreasing resistance rates to gentamicin,erythromycin,rifampicin,and trimethoprim-sulfamethoxazole,but increasing resistance rate to levofloxacin.No vancomycin-resistant strains were detected.The prevalence of linezolid-resistant MRCNS increased from 0.2％to 2.3％over the 7-year period.Conclusions Staphylococcus remains the major pathogen among gram-positive bacteria.MRSA and MRCNS were still the principal antibiotic-resistant gram-positive bacteria.No S.aureus isolates were found resistant to vancomycin or linezolid,but linezolid-resistant strains have been detected in MRCNS isolates,which is an issue of concern.
基金项目
CHINET中国细菌耐药监测网基金(2020QD049)
万方数据