CHINET监测网各医院菌株数.ppt

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,（,2019,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,广州医学院一附院,湖北同济医院,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,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,2019,年我院与国内开展此项工作多年的,8,所医院，,2019,年又增加,4,所医院共同拟定统一的实验方案、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。,一、临床分离菌株的基本情况,2019,年,CHINET,监测网各医院的菌株数,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,2926,1173,广医一附院,1493,589,瑞金医院,2588,1542,儿科医院,2318,1882,协和医院,2889,1768,儿童医院,1794,1190,同济医院,3132,1434,重庆医大一附院,770,197,浙医一附院,2909,1419,甘肃省人民医院,578,223,北京医院,2055,800,新疆医大一附院,(,下半年,),185,147,合计,23637,12364,65.7%,34.3%,2019,年,CHINET,监测网临床分离菌在各类标本中的分布,呼吸道标本,（,49.2,）,尿液标本,（,19.6,）,血液标本,（,11.0,）,伤口脓液（,4.9,）,无菌体液（,4.2,）,生殖道分泌物（,2.2,）,粪便标本（,1.3,）,其他（,7.6,）,主要细菌在各标本中的分布（）,伤口,分泌物,尿液,血液,呼吸道,标本,粪便,克雷伯菌属,(12.0),金葡菌,(,12.0,）,不动杆菌,(12.1),铜绿假单胞菌,(17.0),大肠埃希菌,(47.0),肠球菌,(18.4),克雷伯菌,（,6.9,）,凝,(-),葡萄球菌,(7.4),金葡菌,(23.0),大肠埃希菌,(19.0),铜绿假单胞,(9.0),克雷伯菌,（,6.0,）,凝,(-),葡萄球菌,(50.2),大肠埃希菌,(11.0),金葡菌,(5.0),肠球菌属,（,6.6,）,大肠埃希菌,(28.0),17712,株,468,株,1764,株,3960,株,志贺菌属,(25.0),肠球菌属,(11.0),7056,株,2019,年,23079,株,革兰阴性菌菌种分布,（,%,前十位）,细 菌,检出率,%,2019,年,12153,株革兰阳性菌的分布（,%,）,细 菌,检出率,%,二、临床重要耐药菌的检出率,协和医院,57.3%,北京医院,74.9%,华山医院,80.4%,瑞金医院,67.0%,儿童医院,23.7%,儿科医院,13.5%,浙大一附院,54%,广医一附院,74.7%,武汉同济医院,58.1%,重医一附院,33.3%,MRSA,在中国,中国,CHINET,（,2019,）,新疆医大一,附院,31.0%,甘肃人民医院,64.8%,协和医院,81.6%,北京医院,71.7%,华山医院,83.7%,瑞金医院,65.1%,儿童医院,88.8%,儿科医院,68.9%,浙大一附院,76%,广医一附院,83.9%,武汉同济医院,79.8%,重医一附院,89.9%,中国,CHINET,（,2019,）,新疆医大一,附院,81.3%,甘肃人民医院,77.6%,MRCNS,在中国,2019,年青霉素不敏感肺炎链球菌的检出率,PISP,PRSP,总检出率,儿童,(477),成人,(167),69.2%,13.8%,19.3,%,12.6%,88.5,%,26.4%,成人菌株中青霉素不敏感肺炎链球菌的检出率低于儿童株,2019,年,ESBLs,产生菌的检出率,大肠埃希菌,肺炎克雷伯菌,奇异变形杆菌,55.0%,45.1%,16.4%,8,家医院的大肠埃希菌中的产,ESBLs,菌株的检出率高于肺炎克雷伯菌中的,ESBLs,的检出率,检出率范围,总检出率,12.372.1%,15.470.6%,041.3%,菌株数,6527,3258,548,2019,年多重耐药菌株的检出率,大肠埃希菌,克雷伯菌属,铜绿假单胞菌,检出率范围,总检出率,21.145.0%,32.6%,3.452.2%,23.7%,041.3%,16.4%,鲍曼不动杆菌,026.7%,13.3%,1.964.9%,52.2%,(,新疆、浙医,),(,甘肃、华山,),(,儿科、华山,),(,儿童、浙医,),菌株数,6527,3258,3988,3157,2019,年泛耐药菌株的检出率,弗劳地柠,檬酸杆菌,克雷伯菌属,铜绿假单胞菌,检出率范围,总检出率,030.8%,5.9%,01.5%,0.3%,041.3%,16.4%,鲍曼不动杆菌,08.9%,3.2%,05.3%,2.8%,(,华山,),(,重医,),(,华山,),(,浙医,),泛耐药菌株指的是对第三、四代头孢菌素、酶抑制剂复方制剂、碳青霉烯类、氟喹诺酮类和氨基糖苷类均耐药的菌株。但对多粘菌素敏感,菌株数,3258,3988,3157,222,三、,临床分离细菌的耐药率,2019,年,1397,株,MSSA,耐药率（,%,）,*,除青霉素外，对大多抗菌药物敏感；,*半数菌株对红霉素耐药,2019,年,1963,株,MRSA,耐药率（,%,）,*,仍有,60-70%,菌株对磷霉素、,SMZCO,敏感,*未发现对,VAN,、,TEC,、,LIN,耐药株,2019,年,1017,株,MSCNS,耐药率（,%,）,*,同,MSSA,菌株相仿，,*对,SMZ-TMP,的耐药率,(28.3%),较,MSSA(4.7%),高,;,*对磷霉素的耐药率,(19.1%),较,MSSA(2,，,6%),高,;,2019,年,3326,株,MRCNS,耐药率（,%,）,*,利福平、磷霉素仍有,66-88%,敏感,*对,SMZ-TMP,的耐药率,(61.5%),较,MRSA(26.2%),高,*对庆大霉素的耐药率,(46.5%),较,MRSA(88.9%),低,2019,年粪肠球菌和屎肠球菌的耐药率（,%,）,万古霉素、替考拉宁均有少数耐药株,2019,年,753,株,溶血性链球菌的耐药率（,%,）,抗菌药物,A,（,491,）,B,（,187,）,C,（,22,）,F,（,15,）,G,（,53,）,青霉素,0.2,3.8,0.0,0.0,0.0,红霉素,92.7,43.4,64.7,53.3,51.0,克林霉素,72.3,42.4,63.6,50.0,29.4,头孢呋辛,0.0,3.0,0.0,0.0,0.0,头孢丙烯,0.0,2.8,0.0,0.0,0.0,头孢噻肟,4.1,14.4,9.1,28.6,2.0,头孢曲松,2.9,7.0,4.8,13.3,2.0,万古霉素,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,0.4,24.8,10.5,0.0,0.0,*,对青霉素仍极敏感,*,对红霉素、克林霉素耐药率高,*,未见万古霉素、利奈唑胺的耐药菌株,2019,年儿童患者,477,株肺炎链球菌的耐药率,(%)*,抗菌药物,PSSP,（,55,株）,PISP,（,330,株）,PRSP,（,92,株）,耐药,敏感,耐药,敏感,耐药,敏感,青霉素,0,100.0,0,0,100,0,头孢丙烯,2.2,95.7,2.5,95.3,19.4,53.2,红霉素,81.5,13.0,98.5,1.2,100,0,克林霉素,85.2,13.0,97.0,2.7,100,0,左氧氟沙星,1.9,96.2,0.0,99.7,1.1,98.9,莫西沙星,0,100,0,100,0,100,万古霉素,0,100,0,100,0,100,利奈唑胺,0,100,0,100,0,100,*,包括,2,家儿童医院及,10,家成人医院中儿科病人分离的肺炎链球菌,红霉素、克林霉素耐药率高,2019,年成人患者,167,株肺炎链球菌的耐药率,(%)*,抗菌药物,PSSP,（,123,株）,PISP,（,23,株）,PRSP,（,21,株）,耐药,敏感,耐药,敏感,耐药,敏感,青霉素,0,100.0,0,0,100,0,红霉素,85.0,8.0,91.3,4.3,100.0,0,克林霉素,81.0,16.5,95.7,4.3,95.2,4.8,左氧氟沙星,3.7,90.7,18.2,81.8,0,100.0,莫西沙星,2.7,97.3,4.8,90.5,0,100.0,万古霉素,0,100,0,100,0,100.0,*,成人分离株对红霉素、克林霉素耐药率高,2019,年流感嗜血杆菌的耐药率,(%),抗菌药物,总体（,755,株）,儿童株（,451,）,成人株（,304,株）,耐药,敏感,耐药,敏感,耐药,敏感,氨苄西林,30.1,62.1,35.2,58.1,22.3,68.2,氨苄西林,/,舒巴坦,7.2,92.8,7,93,7.7,92.3,头孢呋辛,1.5,96.9,0.7,98.4,2.7,94.6,头孢噻肟,4.6,95.4,1.8,98.2,8.9,91.1,氯霉素,16.9,75.7,18.4,76.2,14.5,74.9,阿奇霉素,2.8,97.2,2.7,97.3,3,97,环丙沙星,6.9,93.1,1.6,98.4,15.1,84.9,复方磺胺甲噁唑,59.4,38.1,67,31.4,47.8,48.1,儿童株产酶率：,33.1%,，产酶率较高成人株产酶率,(19.5%),高,总体产酶率为,27.4%,；儿童株对喹诺酮类耐药率较低，。,抗菌药,耐药,敏感,阿莫西林,/,克拉维酸,0,100,头孢呋辛,0,98.7,头孢曲松,0,100,左氧氟沙星,0,100,复方磺胺甲噁唑,0,96.2,头孢克洛,1.3,97.4,阿奇霉素,38,62,红霉素,40.7,59.3,克林霉素,61.5,25.6,2019,年,78,株卡他莫拉菌的耐药率,(%)(,稀释法,),产酶率,96.1%(75/78),2019,年,6527,株大肠埃希菌耐药（,%,）,对碳青霉烯类、头孢哌酮,/,舒巴坦、哌拉西林,/,他唑巴坦、阿米卡星的耐药率较低（,10%,）,2019,年大肠埃希菌的耐药率（,%,）,抗菌药物,耐药率,抗菌药物,耐药率,产,ESBL,(3590,株,),非产,ESBL,(2937,株,),产,ESBL,(3590,株,),非产,ESBL,(2937,株,),阿米卡星,11.1,4.1,头孢吡肟,30.4,3.2,庆大霉素,65.2,42.2,头孢哌酮,/,舒巴坦,4.2,1.3,哌拉西林,99.1,47.2,头孢西丁,12.5,8.7,哌拉西林,/,他唑巴坦,7.5,3.0,亚胺培南,0,0.1,头孢呋辛,98.7,15.3,美罗培南,0.1,0.1,头孢噻肟,85.5,7.1,环丙沙星,71.8,44.3,头孢他啶,22.8,3.2,复方磺胺甲噁唑,75.2,55.4,产,ESBL,株对,内酰胺类和其他测试药的耐药率较非产酶株高,对庆大、哌拉西林、,FQ,耐药率均较高,对碳青霉烯类两种酶抑剂复方，,AMK,耐药率均低于,10%,2019,年,3258,株克雷伯菌属细菌耐药率（,%,）,对碳青霉烯类、头孢哌酮,/,舒巴坦耐药率较低（,10%,）,哌拉西林,/,他唑巴坦、阿米卡星耐药率较低（,17%,）,2019,年克雷伯菌属的耐药率（,%,）,抗菌药物,耐药率,抗菌药物,耐药率,产,ESBL,(1463,株,),非产,ESBL,(1781,株,),产,ESBL,(1463,株,),非产,ESBL,(1781,株,),阿米卡星,33.0,4.7,头孢吡肟,35.3,2.7,庆大霉素,59.3,13.6,头孢哌酮,/,舒巴坦,15.3,3.0,哌拉西林,97.5,25.3,头孢西丁,25.1,10.9,哌拉西林,/,他唑巴坦,28.8,7.2,亚胺培南,0.8,0.4,头孢呋辛,96.0,13.4,美罗培南,0.3,0.5,头孢噻肟,82.2,5.6,环丙沙星,46.7,16.0,头孢他啶,48.6,5.1,复方磺胺甲噁唑,67.9,21.9,产,ESBL,株对,内酰胺类和其他测试药的耐药率较非产酶株高,对碳青霉烯类耐药率低,2019,年,548,株变形杆菌属细菌耐药率（,%,）,对碳青霉烯类、头孢哌酮,/,舒巴坦、哌拉西林,/,他唑巴坦、头孢他啶、头孢吡肟,和阿米卡星的耐药率较低（,10%,）,2019,年奇异变形杆菌的耐药率（,%,）,抗菌药物,耐药率,抗菌药物,耐药率,产,ESBL,(68,株,),非产,ESBL,(347,株,),产,ESBL,(68,株,),非产,ESBL,(347,株,),阿米卡星,39.7,4.4,头孢吡肟,26.5,1.7,庆大霉素,73.5,25.0,头孢哌酮,/,舒巴坦,1.5,1.2,哌拉西林,73.1,12.3,头孢西丁,6.5,6.1,哌拉西林,/,他唑巴坦,0,2,亚胺培南,0,0.6,头孢呋辛,91.0,14.47,美罗培南,1.5,0.9,头孢噻肟,54.4,3.2,环丙沙星,61.8,24.6,头孢他啶,20.6,2.6,复方磺胺甲噁唑,86.6,49.2,产,ESBL,株对,内酰胺类和其他测试药的耐药率较非产酶株高,对碳青霉烯类两种酶抑剂复方和头霉素耐药率低于,10%,2019,年,1231,株肠杆菌属细菌耐药率（,%,）,对头孢哌酮,/,舒巴坦、碳青霉烯类、头孢吡肟和阿米卡星的耐药率较低（,15%,）,2019,年,277,株柠檬酸杆菌属细菌耐药率（,%,）,对头孢哌酮,/,舒巴坦和碳青霉烯类耐药率低（,10%,），阿米卡星、头孢吡肟和哌拉西林,/,他唑巴坦次之。,2019,年,127,株摩根菌属细菌耐药率（,%,）,对两种酶抑制剂复方、碳青霉烯类、头孢他啶、头孢吡肟和阿米卡星耐药率低,2019,年,253,株沙雷菌属细菌耐药率（,%,）,对两种酶抑制剂复方、碳青霉烯类、头孢他啶、头孢吡肟、环丙沙星和,SMZCO,的耐药率,10%,，阿米卡星次之。,2019,年,46,株伤寒沙门菌和副伤寒沙门菌,A,耐药率（,%,）,抗菌药物,耐药,敏感,氨苄西林,21.1,78.9,氨苄西林,/,舒巴坦,8.1,89.2,头孢曲松,3.7,92.6,环丙沙星,0.0,89.1,复方磺胺甲噁唑,13.0,84.8,氯霉素,8.7,91.3,2019,年志贺菌的耐药率（,%,）,磷霉素、环丙沙星的耐药率,10%,2019,年,12637,株肠杆菌科细菌耐药率（,%,）,抗菌药物,耐药,敏感,亚胺培南,0.5,99.4,美罗培南,0.5,99.3,阿米卡星,11.7,84.5,头孢哌酮,/,舒巴坦,5.1,82.4,哌拉西林,/,他唑巴坦,10.3,76.9,头孢他啶,19,75.6,头孢吡肟,16.6,74.1,环丙沙星,42.1,50.7,2019,年,3988,株铜绿假单胞菌耐药率（,%,）,IMP,、,MER,的耐药率分别为,35.8%,和,28.5%,左右,2019,年,3157,株不动杆菌属细菌的耐药率（,%,）,对头孢哌酮,/,舒巴坦耐药率低，对其他药耐药率均较高,两种碳青霉烯类耐药率均,35%,2019,年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（,1180,株）,抗菌药物,伯克霍尔德菌属（,254,株）,耐药,敏感,耐药,敏感,头孢哌酮,/,舒巴坦,16.3,63.4,哌拉西林,/,他唑巴坦,16.5,76.9,左氧氟沙星,12.9,84,头孢他啶,15.4,79.8,复方磺胺甲噁唑,11.4,87.9,美罗培南,22.9,76.3,米诺环素,1.5,97.4,复方磺胺甲噁唑,14.7,83.2,米诺环素,3.8,90.4,*米诺环素的耐药率低,(,5%),2019,年,9644,株非发酵菌耐药率（,%,）,抗菌药物,耐药,敏感,头孢哌酮,/,舒巴坦,15.6,63.9,美罗培南,37.9,59,亚胺培南,41.8,56,头孢他啶,38.3,55.3,阿米卡星,39.8,55.3,哌拉西林,/,他唑巴坦,39.6,55.1,环丙沙星,39.9,52.5,头孢吡肟,38.3,52,小结,对国内主要地区,12,所医院（,10,所综合性医院和,2,所儿童医院）临床分离菌进行细菌耐药性监测,2019,年共收集,36001,株菌，其中革兰阳性菌占,34.3,，革兰阴性菌占,65.7,。门诊和住院患者分离菌分别占,13.7,、,86.3,。,最常见的革兰阳性菌为金葡菌、肠球菌属、凝固酶阴性葡萄球菌等。最常见的革兰阴性菌为大肠埃希菌、铜绿假单胞菌、克雷伯菌属、不动杆菌属、肠杆菌属、嗜麦芽窄食单胞菌等。,金葡菌和凝固酶阴性葡萄球菌中甲氧西林耐药株平均约为,58,和,77,，大肠埃希菌、克雷伯菌属（肺炎克雷伯菌和产酸克雷伯菌）中产,ESBL,株约占,55,、,45,。,小结,葡萄球菌属中甲氧西林耐药株对,内酰胺类和其他抗菌药的耐药率均显著高于甲氧西林敏感株，但仍有约,60-80,的菌株对磷霉素、,SMZCO,、利福平敏感，未发现对万古霉素、替考拉宁和利奈唑胺耐药株。,肠球菌属中粪肠球菌对多数药物的耐药率低于屎肠球菌（除氯霉素），尤其对呋喃妥因和磷霉素的耐药率均低于,10,。未发现耐利奈唑胺菌株，两者中均发现少数对万古霉素、替考拉宁耐药株。经,PCR,检测，,27,株耐万古株,(,粪肠,6,，屎肠,21),均系,vanA,型耐药。,溶血性链球菌对青霉素仍极敏感，但对红霉素、克林霉素耐药率高。,小结,大肠埃希菌、（肺炎克雷伯菌和产酸克雷伯菌）、奇异变形杆菌中产,ESBL,株对抗菌药的耐药率比非产,ESBL,株耐药率高。,伤寒和副伤寒沙门菌对氯霉素、氨苄西林、,SMZCO,仍有约,80,-90,的敏感率，对头孢曲松、环丙沙星的敏感率约,90,。志贺菌属对前三种抗菌药的耐药率为,70-99,，但对磷霉素和环丙沙星的耐药率,10,。,流感嗜血杆菌产酶率为,27.4,，该菌对多数抗菌药的耐药率较低，儿童株对喹诺酮类的耐药率低于成人株。,肺炎链球菌对红霉素、克林霉素耐药率高，儿童分离株中,PSSP,、,PISP,、,PRSP,分别占,11.5,、,69.2,、,19.3,；成人分离株中为,73.7,、,13.8,、,12.6,。,小结,肠杆菌科细菌对碳青霉烯类仍高度敏感，耐药率,1,，其次为阿米卡星、头孢哌酮,/,舒巴坦，对哌拉西林,/,他唑巴坦、头孢他啶、头孢吡肟仍有约,75,的敏感率。,铜绿假单胞菌和不动杆菌属对碳青霉烯类耐药率均,28,-40,，对所测试抗菌药耐药率均较高。不动杆菌属对头孢哌酮,/,舒巴坦的耐药率仅,5.3,。,CLSI,仅推荐少数抗菌药用于嗜麦芽窄食单胞菌和伯克霍尔德菌的药敏试验（不包括碳青霉烯类），米诺环素对上述细菌的敏感率均在,90,以上。,非发酵革兰阴性菌对抗菌药的耐药率均较肠杆菌科细菌高，以对头孢哌酮,/,舒巴坦的耐药率最低，为,15.6,。,多数医院中均发现了少数泛耐药铜绿假单胞菌、鲍曼不动杆菌，个别医院中出现肺炎克雷伯菌和弗劳地柠檬酸杆菌。,THANK YOU,！,CHINET,监测,