CHINET全年耐药监测统计结果课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,11/7/2009,#,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,（,2010,年）,参加单位,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,浙医一附院,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,重庆医大一附院,甘肃省人民医院,新疆医大一附院,安徽医科大学一附院,昆明医学院一附院,材料,细菌,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。,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。,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,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,MIC,加以确认，或用,PCR,扩增,vanA,、,vanB,、,vanC,等基因证实。,结果判断和数据分析,CLSI 2010,版判断药敏试验结果,采用,WHONET5.6,软统计分析数据。,2010,年,CHINET,监测网各医院的菌株数（,47850,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,3113,1016,儿科医院,2407,1750,瑞金医院,3301,1319,儿童医院,1629,1339,协和医院,3860,1627,重庆医大一附院,1463,277,同济医院,3209,1329,甘肃省人民医院,1317,315,浙医一附院,3869,1551,新疆医大一附院,2058,647,北京医院,1521,524,安徽医科大学一附院,2412,827,广医一附院,2125,345,昆明医学院一附院,1998,702,合计,34282,13568,71.6%,28.4%,2010,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,（,85.8,）,（,41060/47850,）,门诊患者,（,14.2,）,（,6790/47850,）,2010,年,CHINET,监测网临床分离菌在各类标本中的分布,呼吸道标本,（,46.9,）,尿液标本,（,19.9,）,血液标本,（,11.9,）,伤口脓液（,5.2,）,无菌体液（,4.0,）,生殖道分泌物（,1.7,）,粪便标本（,1.2,）,其他（,8.2,）,脑脊液（,1.0,）,CHINET,耐药监测革兰阴性菌菌种分布,细菌,株数,细菌,株数,大肠埃希菌,9225,26.91,摩根菌属,195,0.57,克雷伯菌属,5529,16.13,产碱杆菌,107,0.31,不动杆菌属,5523,16.11,少动鞘氨醇单胞菌,94,0.27,铜绿假单胞菌,5080,14.82,金杆菌属,92,0.27,肠杆菌属,1961,5.72,罗尔斯顿菌属,74,0.22,嗜麦芽窄食单胞菌,1661,4.85,气单胞菌属,76,0.22,变形杆菌属,907,2.65,多源菌属,53,0.15,流感嗜血杆菌,734,2.14,普罗威登菌属,46,0.13,沙雷菌属,437,1.27,志贺菌属,149,0.43,其他假单胞菌,420,1.23,丛毛单胞菌,14,0.04,其他嗜血杆菌,395,1.15,奈瑟菌属,11,0.03,沙门菌属,355,1.04,博特菌属,13,0.04,柠檬酸杆菌属,350,1.02,黄杆菌属,16,0.05,伯克霍尔德菌属,320,0.93,其他,218,0.64,莫拉菌属,227,0.66,合计,34282,100.0,CHINET,耐药监测革兰阳性菌菌种分布,细菌,株数,金葡菌,4452,32.81,肠球菌属,4046,29.82,凝固酶阴性葡萄球菌,3078,22.69,（血液脑脊液等无菌体液）,肺炎链球菌,944,6.96,-,溶血性链球菌,808,5.96,草绿色链球菌（血液及无菌体液）,186,1.37,其他,54,0.40,合计,13568,100.0,2010,年,CHINET,监测网各医院金葡菌,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,265/409,64.8,上海儿科医院,/,42/365,11.5,瑞金医院,274/443,61.9,上海儿童医院,/,115/470,24.5,协和医院,243/560,43.4,重庆医大一附院,/,76/125,60.8,同济医院,361/578,62.5,甘肃省人民医院,/,85/142,59.9,浙医一附院,103/209,49.3,新疆医大一附院,/,207/349,59.3,广州一附院,66/101,65.3,安徽医大一附院,169/277,61.0,北京医院,191/246,77.6,昆明医大一附院,103/178,57.9,总计,2300/4452,51.7,2010,年,CHINET,监测网各医院凝固酶,(-),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,99/124,79.8,上海儿科医院,/,327/505,64.8,瑞金医院,135/160,84.4,上海儿童医院,/,373/411,90.8,协和医院,168/268,62.7,重庆医大一附院,/,21/22,95.5,同济医院,154/186,82.8,甘肃省人民医院,/,30/37,81.1,浙医一附院,478/714,66.9,新疆医大一附院,/,48/62,77.4,广州一附院,41/49,83.7,安徽医大一附院,185/224,82.6,北京医院,39/52,75.0,昆明医大一附院,204/264,77.3,总计,2302/3078,74.8,MSSA(2177,株,),与,MRSA(2302,株,),的耐药率（,%,）,MRSA,的耐药率,MSSA,约,80%,和,70%,的菌株对,TMP/SMZ,、磷霉素仍敏感,MSSA,对,内酰胺类、,TMP/SMZ,、磷霉素、利福平和左氧氟沙星的耐药率,10%,无万古霉素、利奈唑胺或替考拉宁耐药株,MSCNS(817,株,),和,MRCNS(2302,株,),的耐药率（,%,）,MRCNS,的耐药率,MSCNS,MRCNS,中有,88%,、,77%,和,73%,的菌株对利福平、氨苄西林,/,舒巴坦、磷霉素仍敏感,无万古霉素、利奈唑胺或替考拉宁耐药株,2010,年,14,家医院粪肠球菌,(1829,株,),和屎肠球菌,(1817,株,),的耐药率（,%,）,屎肠球菌的耐药率粪肠球菌，但氯霉素反之,粪肠球菌对呋喃妥因、磷霉素、氨苄西林的耐药率低,少数屎肠球菌、粪肠球菌对万古霉素、利奈唑胺或替考拉宁耐药,2010,年,14,家医院株,溶血性链球菌的耐药率（,%,）,抗菌药物,A,（,253,）,B,（,421,）,C,（,69,）,G,（,28,）,草链*,（,186,）,青霉素,1.2,2.0,3.4,3.7,13.8,红霉素,85.8,62.1,54.4,50.0,61.0,克林霉素,88.5,54.2,46.3,57.7,51.8,头孢呋辛,0.5,2.5,0.0,1.0,头孢丙烯,0.5,0.0,头孢噻肟,6.1,10.2,7.9,0.0,15.3,头孢曲松,8.9,7.9,10.8,0.0,19.0,万古霉素,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,0.0,30.6,14.7,4.0,10.9,2010,年,14,家医院,9225,株大肠埃希菌耐药率（,%,）,2010,年,14,家医院,5529,株克雷伯菌属耐药率（,%,）,2010,年,14,家医院,907,株变形杆菌属耐药率（,%,）,2010,年,14,家医院,1961,株肠杆菌属细菌耐药率（,%,）,2010,年,14,家医院,350,株柠檬酸杆菌属细菌耐药率（,%,）,2010,年,14,家医院,195,株摩根菌属细菌耐药率（,%,）,2010,年,14,家医院,437,株沙雷菌属细菌耐药率（,%,）,2010,年,14,家医院,355,株沙门菌属细菌耐药率（,%,）,抗菌药物,耐药,敏感,氨苄西林,56.2,42.6,氨苄西林,/,舒巴坦,24.8,52.1,阿莫西林,/,克拉维酸,18.3,61.4,头孢哌酮,/,舒巴坦,0.0,89.9,头孢曲松,14.6,81.8,环丙沙星,4.6,76.2,复方磺胺甲噁唑,40.6,57.9,磷霉素,1.7,98.3,氯霉素,35.7,63.5,2010,年,14,家医院福氏志贺菌和宋内志贺菌的敏感性（,%,）,抗菌药物,福氏志贺菌（,54,株）,宋内志贺菌（,86,株）,耐药,敏感,耐药,敏感,氨苄西林,100.0,0.0,92.6,6.0,氨苄西林,/,舒巴坦,60.4,10.4,9.6,67.5,头孢曲松,60.0,40.0,53.8,46.2,环丙沙星,48.2,37.5,2.3,89.5,复方磺胺甲噁唑,65.5,30.9,90.5,8.3,磷霉素,2.6,97.4,1.6,98.4,氯霉素,68.2,25.0,3.2,95.2,2010,年,14,家医院,19289,株肠杆菌科细菌耐药率（,%,）,抗菌药物,耐药,敏感,亚胺培南,4.6,87.6,美罗培南,4.2,91.8,厄他培南,5.9,83.9,阿米卡星,10.0,87.0,哌拉西林,/,他唑巴坦,10.4,79.3,头孢哌酮,/,舒巴坦,9.1,75.3,头孢他啶,31.0,61.6,头孢吡肟,22.0,69.6,庆大霉素,41.1,56.9,2010,年,14,家医院,5080,株铜绿假单胞菌耐药率（,%,）,2010,年,14,家医院,5523,株不动杆菌属,(,鲍曼不动,89.6%),细菌的耐药率（,%,）,除头孢哌酮,/,舒巴坦、米诺环素外，其余抗菌药的耐药率均,50%,亚胺培南和美罗培南的耐药率接近,60%,2010,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（,%,）,抗菌药物,嗜麦芽窄食单胞菌（,1661,株）,抗菌药物,伯克霍尔德菌属（,320,株）,耐药,敏感,耐药,敏感,头孢哌酮,/,舒巴坦,13.8,65.2,哌拉西林,/,他唑巴坦,22.1,70.4,左氧氟沙星,10.7,86.1,头孢他啶,21.8,72.8,复方磺胺甲噁唑,11.2,86.7,美罗培南,19.7,70.3,米诺环素,3.4,82.1,复方磺胺甲噁唑,27.6,64.0,米诺环素,17.6,68.1,CHINET,各医院铜绿假单胞菌对亚胺培南和美罗培南的耐