2022年医学专题—CHINET2013年细菌耐药监测

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,中国,(zhn u),细菌耐药性监测,-,CHINET,监测,（,2013,年）,参加单位,(dnwi),上海华山医院,上海瑞金医院,北京协和医院,卫生部北京医院,上海儿科医院,湖北同济医院,广州医学院一附院,上海市儿童医院,安徽医科大学一附院,浙江邵逸夫医院,甘肃省人民医院,新疆医大一附院,昆明医学院一附院,中国医大一附院,天津医科大学总院,四川大学,(s chun d xu),华西医院,第一页，共四十五页。,材料,(cilio),细菌,日,12.31,日临床分离,(fnl),株,剔除同一患者分离的重复菌株（血液和脑脊液除外）,剔除非无菌体液分离的凝固酶阴性葡萄球菌和草绿色链球菌,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。,抗菌药物纸片,抗菌药物纸片为,BBL,公司或,Oxoid,公司商品。,第二页，共四十五页。,方法,(fngf),药敏试验,纸片扩散法（,Kirby-bauer,）,自动化仪器检测,MIC,值,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 2013,年版判断结果,万古霉素对葡萄球菌的药敏试验采用,(ciyng),MIC,法,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,第三页，共四十五页。,XDR,菌株的统计,(tngj),方法,由于不是,(b shi),所有医院均做了黏菌素和替加环素的药敏，故本次只统计广泛耐药株（,XDR,），而未能统计全耐药株（,PDR,）,由于部分医院药敏试验采用,MIC,法，或,MIC,法和纸片法并行，同一菌株所选用的抗菌药物种类有所差别，因此统计时必须仔细查看各医院的抗菌药物种类，再进行设定。,XDR,统计标准：对除黏菌素和替加环素外其他抗菌药物全耐药者,第四页，共四十五页。,方法,(fngf),青霉素不敏感肺炎链球菌的检测,1,m,g/,片苯唑西林,(x ln),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,MIC,加以确认，或用,PCR,扩增,vanA,、,vanB,、,vanC,等基因证实。,数据分析,采用,WHONET5.6,软件统计分析数据。,第五页，共四十五页。,2013,年,CHINET,监测网各医院,(yyun),的菌株数（,84572,株）,医院,革兰阴性菌,革兰阳性菌,医院,革兰阴性菌,革兰阳性菌,华山医院,3247,1122,甘肃省人民医院,2282,703,瑞金医院,3610,1377,新疆医大一附院,4923,1478,协和医院,5147,2089,安徽医科大学一附院,3256,1079,同济医院,6372,3041,昆明医学院一附院,2844,1252,北京医院,1760,623,浙江邵逸夫医院,3342,1363,广医一附院,3157,546,中国医大一附院,2968,1407,儿科医院,3980,2095,天津医科大学总院,7041,1899,儿童医院,1708,1353,四川大学华西医院,6072,1436,合计,61709,（,73.0%,）,22863,（,27.0%,）,第六页，共四十五页。,2013,年,CHINET,监测网临床,(ln chun),分离菌在门急诊和住院患者中的分布,住院,(zh yun),患者,（,86.2,）,（,63184/84572,）,门急诊患者,(hunzh),（,13.8,）,（,11634/84572,）,第七页，共四十五页。,2013,年,CHINET,监测网,84572,株临床分离菌在各类标本,(biobn),中的分布,呼吸道标本,(biobn),（,43.2,）,尿液标本,(biobn),（,20.9,）,血液标本,（,13.1,）,伤口脓液（,9.8,）,无菌体液（,4.8,）,生殖道分泌物（,2.1,）,粪便标本（,1.6,）,其他（,3.3,）,脑脊液（,1.3,）,第八页，共四十五页。,CHINET,耐药监测,(jin c),革兰阴性菌菌种分布,细菌,株数,细菌,株数,大肠埃希菌,16794,27.21,其他嗜血杆菌,177,0.29,克雷伯菌属,12121,19.64,拉乌尔菌属,114,0.18,不动杆菌属,10120,16.40,多源菌属,75,0.12,铜绿假单胞菌,8257,13.38,志贺菌属,77,0.12,肠杆菌属,3816,6.18,产碱杆菌,52,0.08,嗜麦芽窄食单胞菌,2444,3.96,奈瑟菌属,30,0.05,变形杆菌属,1835,2.97,罗尔斯顿菌属,28,0.05,沙雷菌属,1059,1.71,丛毛单胞菌,25,0.04,流感嗜血杆菌,968,1.57,普罗威登菌属,21,0.03,沙门菌属,877,1.42,气单胞菌属,21,0.03,柠檬酸杆菌属,789,1.28,黄杆菌属,15,0.02,伯克霍尔德菌属,770,1.25,金杆菌属,15,0.02,其他假单胞菌,523,0.85,博特菌属,6,0.01,摩根菌属,298,0.48,其他,91,0.15,莫拉菌属,291,0.47,合计,61709,100.0,第九页，共四十五页。,CHINET,耐药监测,(jin c),革兰阳性菌菌种分布,细菌,株数,金葡菌,8127,35.55,肠球菌属,7058,30.87,凝固酶阴性葡萄球菌,4354,19.04,（血液脑脊液等无菌体液）,肺炎链球菌,1429,6.25,-,溶血性链球菌,1289,5.64,草绿色链球菌（血液及无菌体液）,515,2.25,其他,91,0.40,合计,22863,100.0,第十页，共四十五页。,2013,年,CHINET,监测网各医院,(yyun),金葡菌,MR,菌株检出率,医院,金黄色葡萄球菌,医院,金黄色葡萄球菌,MR,株数,/,总株数,（,%,）,MR,株数,/,总株数,（,%,）,华山医院,304/503,60.4,甘肃省人民医院,134/326,41.1,瑞金医院,230/410,56.1,新疆医大一附院,186/569,32.7,协和医院,244/700,34.9,安徽医大一附院,176/359,49.0,同济医院,1047/1492,70.2,昆明医大一附院,100/280,35.7,广州一附院,82/196,41.8,浙江邵逸夫医院,170/406,41.9,北京医院,167/232,72.0,中国医大一附院,167/438,38.1,上海儿科医院,123/517,23.8,天津医大总院,200/640,31.3,上海儿童医院,163/434,37.6,四川大学华西医院,179/625,28.6,总计,3672/8127,45.2,第十一页，共四十五页。,2013,年,CHINET,监测网各医院凝固,(nngg),酶,(-),葡萄球菌,MR,菌株检出率,医院,凝固酶阴性葡萄球菌,医院,凝固酶阴性葡萄球菌,MR,株数,/,总株数,（,%,）,MR,株数,/,总株数,（,%,）,华山医院,77/141,54.6,甘肃省人民医院,88/108,81.5,瑞金医院,42/108,38.9,新疆医大一附院,260/309,84.1,协和医院,123/179,68.7,安徽医大一附院,195/262,74.4,同济医院,345/418,82.5,昆明医大一附院,285/401,71.1,广州一附院,42/60,70.0,浙江邵逸夫医院,281/331,84.9,北京医院,28/78,35.9,中国医大一附院,340/396,85.9,上海儿科医院,443/613,72.3,天津医大总院,211/276,76.4,上海儿童医院,189/382,49.5,四川大学华西医院,251/292,86.0,总计,3200/4354,73.5,第十二页，共四十五页。,MSSA(4620,株,),与,MRSA(3672,株,),的耐药率（,%,）,第十三页，共四十五页。,MSCNS(1762,株,),和,MRCNS(3200,株,),的耐药率（,%,）,第十四页，共四十五页。,2013,年,16,家医院,(yyun),粪肠球菌,(3283,株,),和屎肠球菌,(3062,株,),的耐药率（,%,）,第十五页，共四十五页。,2013,年,16,家医院,(yyun),株,溶血性链球菌的耐药率（,%,）,抗菌药物,A,（,193,）,B,（,823,）,C,（,104,）,G,（,72,）,草链,（,515,）,青霉素,2.9,1.2,20.7,0.0,7.3,红霉素,87.2,62.5,73.4,58.8,61.5,克林霉素,80.9,55.0,65.8,57.6,58.8,头孢呋辛,0.0,0.8,6.2,2.3,8.5,头孢噻肟,5.0,9.5,12.5,7.9,15.2,头孢曲松,2.4,6.2,2.3,9.8,14.3,万古霉素,0.0,0.0,0.0,0.0,0.0,利奈唑胺,0.0,0.0,0.0,0.0,0.0,左氧氟沙星,0.6,41.4,7.6,7,16.4,第十六页，共四十五页。,2013,年,CHINET,监测网各医院,(yyun),产,ESBL,菌株检出率,医院,大肠埃希菌,肺克和产酸,奇异变形杆菌,产,ESBLs,株数,/,总株数,（,%,）,产,ESBLs,株数,/,总株数,（,%,）,产,ESBLs,株数,/,总株数,（,%,）,华山医院,408/664,61.4,168/720,23.3,40/83,48.2,瑞金医院,/,/,/,/,/,/,协和医院,696/1410,49.4,217/924,23.5,30/133,22.6,同济医院,1069/1497,71.4,529/1081,48.9,18/76,23.7,北京医院,/,/,/,/,/,/,广州一附院,334/726,46.0,112/393,28.5,0/86,0.0,上海儿科医院,723/1441,50.2,308/572,53.8,3/67,4.5,上海儿童医院,303/559,54.2,209/309,67.6,5/48,10.4,甘肃省人民医院,413/859,48.1,86/524,16.4,9/56,16.1,新疆医大一附院,601/1350,44.5,327/1169,28.0,27/140,19.3,安徽医大一附院,578/1021,56.6,200/565,35.4,0/62,0.0,云南医大一附院,626/1097,57.1,211/633,33.3,1/34,2.9,浙医邵逸夫医院,530/1068,49.6,117/591,19.8,26/161,16.1,中国医大一附院,378/707,53.5,183/578,31.7,30/91,33.0,天津医大总院,584/1170,49.9,392/1595,24.6,32/178,18.0,四川大学华西医院,971/1636,59.4,466/1420,32.8,0/121,0.0,合计,8214/15205,54.0,3525/11074,31.8,221/1336,16.5,第十七页，共四十五页。,2013,年,16,家医院,(