2009-CHINET2009耐药监测统计结果(终稿)

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,中国细菌耐药性监测,-,CHINET,监测,（,2009,参加单位,浙医一附院,重庆医大一附院,新疆医大一附院,1,前言,细菌耐药性已成为全球医疗领域中最受关注的问题,世界范围内有许多著名的细菌耐药性监测网：,EARSS MYSTIC SENTRY JAARM NNIS PROTEKT,国内也已有多个地区组成的耐药监测网进行该项工作,监测方案、实验材料、方法和判断标准各不相同，导致耐药监测结果缺乏可比性，难以汇总、分析和总结,2009,年我院与国内开展此项工作多年的,14,所医院按照统一的试验方案、采用统一的材料、方法和判断标准，进行细菌耐药性监测以期获得统一、准确、代表性较广的监测数据，供医疗、制药、卫生保健部门参考。,2,材料,细菌,2009.1.1,日,12.31,日临床分离株,剔除同一患者相同部位的重复菌株,按统一方案进行抗菌药物敏感试验,培养基,药敏试验用,MH,琼脂，为,oxoid,公司商品。,3,材料,抗菌药物纸片,抗菌药物纸片,(,包括头孢他啶克拉维酸、头孢噻肟克拉维酸纸片,),和头孢硝噻吩纸片为,BBL,公司或,Oxoid,公司商品。,卡他莫拉菌药敏试验用琼脂稀释法做。,4,方法,药敏试验,采用纸片扩散法进行,(Kirby-bauer),质控菌：大肠埃希菌,ATCC 25922,，铜绿假单胞菌,ATCC 27853,，金葡菌,ATCC 25923,，肺炎链球菌,ATCC 49619,和流感嗜血杆菌,ATCC 49247,。,药敏试验结果按,CLSI 2008,年版判断结果,内酰胺酶检测,头孢硝噻吩纸片法定性检测流感嗜血杆菌和卡他莫拉菌中的,内酰胺酶,CLSI 2008,年版推荐的,ESBL,纸片筛选和酶抑制剂增强纸片确证法测定大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌和奇异变形杆菌中产,ESBLs,株。,5,方法,青霉素不敏感肺炎链球菌的检测,1,m,g/,片苯唑西林纸片测定肺炎链球菌的抑菌圈,直径,19mm,者用青霉素,E,试验条进一步测定其,MIC,耐万古霉素肠球菌的检测：,凡万古霉素纸片扩散法结果为非敏感的菌株，用万古霉素,E,试验条加以确认，并用,PCR,扩增,vanA,、,vanB,、,vanC,等基因证实。,结果判断和数据分析,CLSI 2009,版判断药敏试验结果,采用,WHONET5.5,软统计分析数据。,6,2009,年,CHINET,监测网各医院的菌株数,7,2009,年,CHINET,监测网临床分离菌在门诊和住院患者中的分布,住院患者,（,87.5,）,（,38196/43670,）,门诊患者,（,12.5,）,（,5474/43670,）,8,2009,年,CHINET,监测网临床分离菌在各类标本中的分布,呼吸道标本,（,49.7,）,尿液标本,（,19.9,）,血液标本,（,10.8,）,伤口脓液（,5.3,）,无菌体液（,4.8,）,生殖道分泌物（,1.7,）,粪便标本（,0.6,）,其他（,7.2,）,9,CHINET,耐药监测革兰阴性菌菌种分布,10,CHINET,耐药监测革兰阳性菌菌种分布,11,2009,年,CHINET,监测网各医院金葡菌,MR,菌株检出率,12,2009,年,CHINET,监测网各医院凝固酶,(-),葡萄球菌,MR,菌株检出率,13,MSSA(1755,株,),与,MRSA(2167,株,),的耐药率（,%,）,MRSA,的耐药率,MSSA,81%,、,73%,的菌株对,TMP/SMZ,、磷霉素敏感,MSSA,对,内酰胺酶、,TMP/SMZ,、磷霉素、利福平和左氧氟沙星的耐药率,10%,无万古霉素、利奈唑胺和替考拉宁耐药株,14,MSCNS(730,株,),和,MRCNS(1967,株,),的耐药率（,%,）,MRCNS,的耐药率,MSCNS,MRCNS,的耐药率,MRSA,，但对,TMP/SMZ,相反（,61%/18.4%,），,有,90%,、,70%,菌株对利福平、磷霉素敏感,无万古霉素、利奈唑胺和替考拉宁耐药株,MRCNS,耐甲氧西林凝固酶阴性葡萄球菌,MSCNS,甲氧西林敏感凝固酶阴性葡萄球菌,15,2009,年,14,家医院粪肠球菌,(1764,株,),和屎肠球菌,(1605,株,),的耐药率（,%,）,屎肠球菌耐药率粪肠球菌，但对氯霉素反之。,粪肠球菌对呋喃妥因、磷霉素耐药率低,少数屎肠球菌、粪肠球菌对万古霉素、替考拉宁和利奈唑胺耐药,16,2009,年,14,家医院,649,株,溶血性链球菌的耐药率（,%,）,抗菌药物,A,（,265,）,B,（,264,）,C,（,68,）,G,（,33,）,F,(16),草链*,（,151,）,青霉素,0.4,1.7,4.8,0.0,0.0,13.2,红霉素,82.1,57.6,61.8,60.6,62.5,61.0,克林霉素,66.5,47.1,62.1,68.8,50.0,58.3,头孢呋辛,0.0,0.9,0.0,0.0,0.0,8.0,头孢丙烯,0.0,6.9,0.0,0.0,0.0,21.4,头孢噻肟,2.9,7.0,8.9,0.0,16.7,12.4,头孢曲松,3.7,12.0,12.9,3.3,13.3,14.3,万古霉素,0.0,0.0,0.0,0.0,0.0,0.0,利奈唑胺,0.0,0.0,0.0,0.0,0.0,0.0,左氧氟沙星,0.8,29.8,3.8,0.0,0.0,20.0,*草链系分离自血液、脑脊液等无菌体液标本,对青霉素仍极敏感，但草链耐药率上升（,4.5% 13%,）,红霉素、克林霉素耐药率高,对第三代头孢菌素有少数耐药株,无利奈唑胺耐药株,17,2009,年,CHINET,监测网各医院产,ESBL,菌株检出率,18,2009,年,14,家医院克雷伯菌属的耐药率（,%,）,产,ESBL,株对,内酰胺类、,FQ,、氨基糖苷类、磺胺类的耐药率比非产,ESBL,株高，对碳青霉烯类耐药率较,2008,年高,19,2009,年,14,家医院大肠埃希菌的耐药率（,%,）,产,ESBL,株对,内酰胺类和其他测试药的耐药率高于非产酶株,对,FQ,、庆大霉素、哌拉西林的耐药率极高（,60%,）,对碳青霉烯类、两种酶抑制剂复方的耐药率低,20,2009,年,14,家医院奇异变形杆菌的耐药率（,%,）,产,ESBL,株对,内酰胺类和其他测试药的耐药率高于非产酶株,对,FQ,、庆大霉素、哌拉西林的耐药率极高（,60%,）,对碳青霉烯类、两种酶抑制剂复方的耐药率低,21,2009,年,14,家医院,1684,株肠杆菌属细菌耐药率（,%,）,对碳青霉烯类的耐药率低（,5%,）,对阿米卡星、头孢吡肟、两种酶抑制剂复方的耐药率,20%,22,2009,年,14,家医院,345,株柠檬酸杆菌属细菌耐药率（,%,）,对碳青霉烯类的耐药率低,对两种酶抑制剂复方、头孢吡肟、阿米卡星的耐药率,20%,23,2009,年,14,家医院,146,株摩根菌属细菌耐药率（,%,）,对碳青霉烯类、两种酶抑制剂复方、头孢吡肟、阿米卡星的耐药率,5%,第三代头孢菌素的耐药率为,10%,左右,24,2009,年,14,家医院,389,株沙雷菌属细菌耐药率（,%,）,对碳青霉烯类的耐药率,2%,两种酶抑制剂复方的耐药率,5%,FQ,、第,3,、,4,代头孢菌素、阿米卡星的耐药率,20%,25,2009,年,14,家医院,36,株伤寒沙门菌和副伤寒沙门菌,A,耐药率（,%,）,对氯霉素,100%,敏感,氨苄西林,/,舒巴坦、,FQ,、,TMP/SMZ,、头孢曲松的耐药率均有上升（,S% 60% 87.5%,）,对一线药（氨苄西林、碳青霉烯类）的耐药率上升,26,2009,年,14,家医院志贺菌的耐药率（,%,）,抗菌药物,福氏志贺菌,（,52,株）,宋氏志贺菌,（,14,株）,耐药,敏感,耐药,敏感,氨苄西林,93.5,6.5,76.9,23.1,氨苄西林,/,舒巴坦,69.7,9.1,45.5,27.3,头孢曲松,51.9,37.0,33.3,66.7,环丙沙星,41.3,43.5,0.0,80.0,复方磺胺甲噁唑,66.0,34.0,100.0,0.0,磷霉素,4.3,87.0,0.0,100.0,氯霉素,52.2,30.4,0.0,100.0,27,2009,年,14,家医院,4912,株铜绿假单胞菌耐药率（,%,）,28,2009,年,14,家医院,16750,株肠杆菌科细菌耐药率（,%,）,抗菌药物,耐药,敏感,亚胺培南,1.3,98.4,美罗培南,1.3,98.5,厄他培南,2.4,96.7,阿米卡星,10.5,86.5,头孢哌酮,/,舒巴坦,7.5,77.1,哌拉西林,/,他唑巴坦,9.2,80.0,头孢他啶,22.7,70.8,头孢吡肟,20.2,70.8,庆大霉素,42.0,56.0,29,2009,年,14,家医院,4796,株不动杆菌属,(,鲍曼不动,86.8%),细菌的耐药率（,%,）,头孢哌酮,/,舒巴坦的耐药率略上升（,14.6% vs 24%,），对其他药物耐药率高（,50%,）,两种碳青霉烯类的耐药率均,50%,或以上,30,2009,年,14,家医院嗜麦芽窄食单胞菌和伯克霍尔德菌属的耐药率（,%,）,31,CHINET,各医院铜绿假单胞菌对亚胺培南和美罗培南的耐药率,儿科、儿童、甘肃耐药率低（,20%,）；较去年下降：重医、北京协和、瑞金,较前年上升：北京医院、新疆 昆明：耐药率最高,32,CHINET,各医院不动杆菌属对亚胺培南和美罗培南的耐药率,各院耐药率均有不同程度上升,浙医位居首位，耐药率保持不变,33,2009,年,14,家医院,12823,株非发酵菌耐药率（,%,）,抗菌药物,耐药,敏感,头孢哌酮,/,舒巴坦,20.5,58.3,美罗培南,41.3,56.0,阿米卡星,36.3,59.8,头孢他啶,36.4,57.6,头孢吡肟,37.6,54.5,哌拉西林,/,他唑巴坦,39.0,55.9,亚胺培南,44.4,52.9,环丙沙星,40.0,53.0,34,2009,年,14,家医院,126,株卡他莫拉菌的敏感性,抗菌药物,MIC,范围,MIC,50,MIC,90,敏感率,（,%,）,头孢克洛,0.015-8,1,8,100,头孢呋辛,0.06-4,1,2,100,头孢曲松,0.015-1,0.25,0.5,100,阿莫西林,/,克拉维酸,0.015-0.5,0.125,0.5,100,阿奇霉素,0.03-64,1.25,64,50.8,克林霉素,0.5-64,10,64,3.2,复方磺胺甲噁唑,0.015-16,0.06,0.25,96,左氧氟沙星,0.03-1,.03,.06,100,产酶率,100.0,（,126/126,）,35,2009,年,14,家医院流感嗜血杆菌的耐药率,(%),36,成人和儿童医院中肺炎链球菌的分布,去除脑脊液标本中的肺炎链球菌（共,10,株，其中,PSSP 2,株，,PRSP 8,株）,37,2009,年儿童患者,638,株肺炎链球菌的耐药率,(%)*,38,2009,年成人患者,177,株肺炎链球菌的耐药率,(%)*,39,2009,年,CHINET,监测各医院泛耐药株数,40,2009,年,CHINET,监测各医院泛耐药株数,41,THANK YOU,！,CHINET,监测,42,