首页|2022年全国血流感染细菌耐药监测报告：革兰阴性菌

2022年全国血流感染细菌耐药监测报告：革兰阴性菌

National bloodstream infection bacterial resistance surveillance report (2022) : Gram-negative bacteria

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目的 监测全国血流感染革兰阴性菌病原谱分布及其耐药趋势，为临床血流感染治疗及细菌耐药防控提供参考。 方法 收集全国血流感染细菌耐药监测联盟成员单位2022年1至12月所有分离自血培养阳性的革兰阴性菌，按照美国临床和实验室标准化研究所（CLSI）推荐的稀释法进行抗菌药物敏感性测定。采用WHONET 5.6和SPSS 25.0软件进行统计分析。 结果 共收集51家医院革兰阴性菌9 035株，其中肠杆菌目细菌7 895株（87.4%），非发酵菌1 140株（12.6%）；排在前5位的病原菌为大肠埃希菌4 510株（49.9%）、肺炎克雷伯菌2 340株（25.9%）、铜绿假单胞菌534株（5.9%）、鲍曼不动杆菌复合体405株（4.5%）及阴沟肠杆菌327株（3.6%）。产超广谱β-内酰胺酶（EBSLs）大肠埃希菌、EBSLs（+）肺炎克雷伯菌和EBSLs（+）变形杆菌属检出率分别为47.1%（2 095/4 452）、21.0%（427/2 033）和41.1%（58/141）；耐碳青霉烯类大肠埃希菌（CREC）、耐碳青霉烯类肺炎克雷伯菌（CRKP）检出率分别为1.3%（58/4 510）和13.1%（307/2 340）；CREC和CRKP对头孢他啶/阿维巴坦的耐药率分别为62.1%（36/58）和9.8%（30/307）。耐碳青霉烯类鲍曼不动杆菌（CRAB）复合体的检出率为59.5%（241/405），鲍曼不动杆菌复合体对替加环素和多黏菌素B的耐药率均<5%。耐碳青霉烯类铜绿假单胞菌（CRPA）的检出率为18.4%（98/534）。血流感染革兰阴性菌构成比及主要耐药菌在不同地区的检出率存在差异，其中CRKP和CRPA检出率差异有统计学意义（χ2=20.489和20.252，P<0.001）。省级医院的CREC、CRKP、CRPA、CRAB、ESBLs（+）大肠埃希菌及ESBLs（+）肺炎克雷伯菌检出率均高于地市级医院（χ2=11.953、81.183、10.404、5.915、12.415和6.459，P<0.01或<0.05）；人均GDP≥92 059元地区的CRPA检出率高于人均GDP<92 059元地区（χ2=6.240，P=0.012）。 结论 我国血流感染革兰阴性菌分离率呈上升趋势，其中大肠埃希菌占首位，肺炎克雷伯菌分离率上升明显；ESBLs（+）大肠埃希菌和ESBLs（+）肺炎克雷伯菌的流行率呈下降趋势，CREC保持低水平流行，CRKP流行率呈下降趋势，CRAB复合体仍保持高水平流行率；我国不同地域的血流感染革兰阴性菌构成比和耐药株略有不同，主要耐药菌在省级医院较为突出。 Objective To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022. Methods The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data. Results During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（n=4 510，49.9%），Klebsiella pneumoniae（n=2 340，25.9%），Pseudomonas aeruginosa（n=534，5.9%），Acinetobacter baumannii complex（n=405，4.5%）and Enterobacter cloacae（n=327，3.6%）. The ESBLs-producing rates in Escherichia coli，Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（χ2=20.489 and 20.252，P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producingEscherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（χ2=11.953，81.183，10.404，5.915，12.415 and 6.459，P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（χ2=6.240，P=0.012）. Conclusions The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.
Objective To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022. Methods The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data. Results During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（n=4 510，49.9%），Klebsiella pneumoniae（n=2 340，25.9%），Pseudomonas aeruginosa（n=534，5.9%），Acinetobacter baumannii complex（n=405，4.5%）and Enterobacter cloacae（n=327，3.6%）. The ESBLs-producing rates in Escherichia coli，Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（χ2=20.489 and 20.252，P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producingEscherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（χ2=11.953，81.183，10.404，5.915，12.415 and 6.459，P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（χ2=6.240，P=0.012）. Conclusions The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

Gram-negative bacteriaAntibacterial resistanceBloodstream infectionChinaResistance surveillance

刘志盈、陈云波、嵇金如、应超群、杨青、孔海深、茆海丰、丁卉、田鹏鹏、宋江勤、刘永云、王际亮、金炎、戴媛媛、周义正、耿燕、陈凤訇、王璐、李岩岩、刘丹、张鹏、曹俊敏、李小燕、宋迪静、强鑫华、李艳红、张秋莹、廖国林、黄颖、张保华、郭良、李爱云、康海全、黄东红、满思金、李卓、尹佑东、梁坤鹏、董海新、刘东华、徐红云、董银樵、徐荣、郑琳、虎淑妍、李建、刘强、栾亮、沈继录、张利侠、全博、颜小平、戚晓燕、乔登嫣、刘卫平、夏修三、孟灵、梁金花、沈萍、肖永红、彭芳

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浙江大学医学院附属第一医院　传染病重症诊治全国重点实验室，杭州　310003

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革兰氏阴性菌 抗药性 血流感染 全国范围 耐药监测

2024

10.3760/cma.j.issn.1674-2397.2024.01.005

中华临床感染病杂志
中华医学会

中华临床感染病杂志

CSTPCD北大核心
影响因子：0.791
ISSN：1674-2397
年,卷(期)：2024.17(1)