本文選題：呼吸道感染 + 病原菌�。� 參考：《中國感染與化療雜志》2016年05期

【摘要】：目的總結(jié)2005-2014年CHINET呼吸道分離菌的分布及耐藥性。方法CHINET成員單位按統(tǒng)一方案、采用統(tǒng)一的材料,藥敏試驗(yàn)采用紙片擴(kuò)散法(K-B法)、自動(dòng)化儀器法及E試驗(yàn)法,按照美國CLSI 2014年版標(biāo)準(zhǔn)判讀結(jié)果,用WHONET 5.6軟件統(tǒng)計(jì)分析呼吸道標(biāo)本分離菌的分布及耐藥性。結(jié)果2005-2014年呼吸道標(biāo)本共分離出229 170株細(xì)菌,其中革蘭陰性菌占78.8%,革蘭陽性菌占18.4%。常見細(xì)菌依次為鮑曼不動(dòng)桿菌(16.7%)、銅綠假單胞菌(16.5%)、肺炎克雷伯菌(14.8%)、金黃色葡萄球菌(金葡菌)(11.8%)、大腸埃希菌(7.1%)、嗜麥芽窄食單胞菌(5.8%)、陰溝腸桿菌(3.8%)、肺炎鏈球菌(3.7%)、流感嗜血桿菌(3.1%)等。藥敏結(jié)果顯示,兒童患者中肺炎鏈球菌青霉素耐藥和中介菌株(PRSP、PISP)檢出率分別為16.1%、23.5%,明顯高于成人患者(3.3%、5.9%),兒童患者中PRSP發(fā)生率明顯增加,從2006年5.4%上升至2013年21.9%;β溶血鏈球菌對(duì)青霉素和頭孢菌素類高度敏感,肺炎鏈球菌和A群鏈球菌對(duì)紅霉素、克林霉素耐藥率80%,對(duì)氟喹諾酮類、萬古霉素、利奈唑胺仍保持較高敏感率。流感嗜血桿菌成人株與兒童株中β內(nèi)酰胺酶檢出率分別為22.7%與36.5%,對(duì)阿奇霉素、頭孢呋辛、左氧氟沙星敏感率90%。金葡菌中未檢出萬古霉素、替考拉寧、利奈唑胺耐藥株,甲氧西林耐藥金葡菌(MRSA)檢出率為60.8%。大腸埃希菌對(duì)碳青霉烯類最敏感(耐藥率3%),其次為頭孢哌酮-舒巴坦、哌拉西林-他唑巴坦(耐藥率10%)。肺炎克雷伯菌對(duì)亞胺培南、美羅培南耐藥率逐年增高,分別從2005年3.1%、2.5%上升至2014年10.3%、14.2%,亞胺培南耐藥肺炎克雷伯菌僅對(duì)替加環(huán)素耐藥率較低為12.8%。鮑曼不動(dòng)桿菌對(duì)米諾環(huán)素、頭孢哌酮-舒巴坦、亞胺培南、美羅培南耐藥率逐年增加,對(duì)替加環(huán)素耐藥率較低為6.7%。銅綠假單胞菌對(duì)主要抗菌藥物耐藥率逐年降低,對(duì)阿米卡星、哌拉西林-他唑巴坦、頭孢哌酮-舒巴坦、頭孢吡肟、頭孢他啶、環(huán)丙沙星、慶大霉素耐藥率30%。結(jié)論呼吸道病原菌仍以革蘭陰性桿菌為主,細(xì)菌耐藥現(xiàn)象嚴(yán)重,臨床應(yīng)重視病原菌的監(jiān)測(cè)并結(jié)合藥敏試驗(yàn)結(jié)果合理使用抗菌藥物。
[Abstract]:Objective to summarize the distribution and drug resistance of respiratory tract isolates from CHINET from 2005 to 2014. Methods according to the unified scheme, the CHINET member units adopted the unified material, the drug sensitivity test was performed by the disk diffusion method, the automatic instrument method and the E test method, and the results were interpreted according to the CLSI 2014 edition of the United States. The distribution and drug resistance of isolated bacteria in respiratory tract samples were analyzed by WHONET 5.6 software. Results A total of 229,170 strains of bacteria were isolated from respiratory tract samples from 2005 to 2014, of which 78.8 were Gram-negative bacteria and 18.4 were Gram-positive bacteria. The common bacteria were Acinetobacter baumannii 16.7m, Pseudomonas aeruginosa 16.5g, Klebsiella pneumoniae 14.8m, Staphylococcus aureus (Staphylococcus aureus 11.881), Escherichia coli 7.1cm, Staphylococcus maltophilia 5.8m, Enterobacter cloacae 3.8m, Streptococcus pneumoniae 3.7am, Haemophilus influenzae 3.11. The results of drug sensitivity showed that the positive rates of penicillin resistance and PISP of streptococcus pneumoniae in children were 16. 1% and 23. 5, respectively, which were significantly higher than those in adults. The incidence of PRSP in children was significantly higher than that in adults. From 5.4% in 2006 to 21.9% in 2013, 尾 -hemolytic streptococcus was highly sensitive to penicillin and cephalosporins, Streptococcus pneumoniae and Group A streptococcus were resistant to erythromycin, clindamycin 80%, fluoroquinolones, vancomycin, The sensitivity of linazolamide was still high. The detection rate of 尾 -lactamases in Haemophilus influenzae adult strain and child strain was 22.7% and 36.5%, respectively. The sensitivity to azithromycin, cefuroxime and levofloxacin was 90%. The positive rate of vancomycin, teicoplanin, linazolamine resistant strain and methicillin-resistant Staphylococcus aureus MRSAwas 60.8%. Escherichia coli was most sensitive to carbapenes (drug resistance rate 3), followed by cefoperazone-sulbactam, piperacillin-tazobactam (resistance rate 10%). The resistance rate of Klebsiella pneumoniae to imipenem and meropenem increased year by year from 3.1% in 2005 to 10.3% in 2014. The resistant rate of imipenem resistant Klebsiella pneumoniae to tegacyclin was 12.8cm. The resistance rate of Acinetobacter baumannii to minocycline, cefoperazone-sulbactam, imipenem and meropenem increased year by year, and the resistance rate to tegacycline was 6.7%. The resistance rate of Pseudomonas aeruginosa to main antimicrobial agents decreased year by year. The resistance rates to amikacin, piperacillin-tazobactam, cefoperazone-sulbactam, cefepime, ceftazidime, ciprofloxacin and gentamicin were 30. Conclusion Gram-negative bacilli are still the main pathogenic bacteria in respiratory tract, and the drug resistance of bacteria is serious. We should pay attention to the monitoring of pathogenic bacteria and use antibiotics rationally in combination with the results of drug sensitivity test.
【作者單位】： 浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院 傳染病診治國家重點(diǎn)實(shí)驗(yàn)室;浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院;上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院;北京協(xié)和醫(yī)院;華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院;復(fù)旦大學(xué)附屬華山醫(yī)院;復(fù)旦大學(xué)附屬兒科醫(yī)院;廣州醫(yī)科大學(xué)附屬第一醫(yī)院;北京醫(yī)院;重慶醫(yī)科大學(xué)附屬第一醫(yī)院;新疆醫(yī)科大學(xué)第一附屬醫(yī)院;上海交通大學(xué)附屬兒童醫(yī)院;甘肅省人民醫(yī)院;安徽醫(yī)科大學(xué)第一附屬醫(yī)院;昆明醫(yī)科大學(xué)第一附屬醫(yī)院;天津醫(yī)科大學(xué)總醫(yī)院;四川大學(xué)華西醫(yī)院;內(nèi)蒙古醫(yī)科大學(xué)附屬醫(yī)院;中國醫(yī)科大學(xué)附屬第一醫(yī)院;
【分類號(hào)】：R446.5

【參考文獻(xiàn)】

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1 胡付品;朱德妹;汪復(fù);蔣曉飛;孫自鏞;陳中舉;胡志東;李金;謝軼;康梅;徐英春;張小江;張朝霞;季萍;王傳清;王愛敏;倪語星;孫景勇;俞云松;林潔;儲(chǔ)云卓;田素飛;徐元宏;沈繼錄;單斌;杜艷;卓超;蘇丹虹;張泓;孔菁;魏蓮花;吳玲;胡云建;艾效曼;;2013年中國CHINET細(xì)菌耐藥性監(jiān)測(cè)[J];中國感染與化療雜志;2014年05期

2 汪s，

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