CHINET解读上海华山抗炎所朱德妹教授.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2021/1/5,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2021/1/5,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,CHINET解读上海华山抗炎所朱德妹教授,CHINET解读上海华山抗炎所朱德妹教授CHINET解读上海华山抗炎所朱德妹教授,材料,细菌,2015.1.1,日,12.31,日临床分离株,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。,2021/1/5,2,方法,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 2015,年版判断结果,万古霉素对葡萄球菌的药敏试验采用,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,2021/1/5,3,方法,青霉素不敏感肺炎链球菌的检测,1mg/,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,Etest,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。,2021/1/5,4,2015,年,CHINET,监测网各医院的菌株数（,88778,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,2921,1154,新疆医大一附院,5546,1621,瑞金医院,3303,1220,安徽医科大学一附院,4104,1417,协和医院,3876,1870,昆明医学院一附院,3319,1480,同济医院,5534,3045,中国医大一附院,3436,1526,北京医院,1608,665,天津医科大学总院,6680,1856,广医一附院,1343,238,四川华西医院,4443,1095,儿科医院,4087,4248,内蒙医科大学一附院,2058,521,儿童医院,1747,1739,宁波龙赛医院,702,268,浙江邵逸夫医院,3343,1248,浦东人民医院,1093,389,甘肃省人民医院,1960,582,湖北秭归县人民医院,1194,299,合计,62297,（,70.2%,）,26481,（,29.8%,）,2021/1/5,5,CHINET,中国细菌耐药性监测网历年来监测的菌株数（革兰阴性菌和阳性菌）,年份,医院数,株数,革兰阴性菌,革兰阳性菌,2005,年,8,22774,15244,7530,2006,年,12,33811,23062,10749,2007,年,12,36001,23637,12364,2008,年,12,36216,25184,11032,2009,年,14,43670,31002,12668,2010,年,14,47850,34282,13568,2011,年,15,59287,42415,16872,2012,年,15,72397,52043,20354,2013,年,16,84572,61709,22863,2014,年,17,78955,57320,21635,2015,20,88778,62297,26481,2021/1/5,6,2015,年,CHINET,监测网临床分离菌在门急诊和住院患者中的分布,住院患者,（,83.5%,）,（,74156/88778,）,门急诊患者,（,16.5%,）,（,14622/88778,）,2021/1/5,7,CHINET,中国细菌耐药性监测网历年来监测的菌株数（住院和门诊患者）,年份,医院数,株数,2005,年,8,22774,2006,年,12,33811,2007,年,12,36001,2008,年,12,36216,2009,年,14,43670,2010,年,14,47850,2011,年,15,59287,2012,年,15,72397,2013,年,16,84572,2014,年,17,78955,2015,20,88778,2021/1/5,8,2015,年,CHINET,监测网,88778,株临床分离菌在各类标本中的分布,呼吸道标本,（,42.8%,）,尿液标本,（,22.1%,）,血液标本,（,12.0%,）,无菌体液（,6.3%,）,生殖道分泌物（,1.7%,）,粪便标本（,1.4%,）,其他（,7.6%,）,脑脊液（,1.1%,）,伤口脓液（,5.1%,）,2021/1/5,9,CHINET,中国细菌耐药性监测网历年来监测的菌株数（标本来源）,年份,菌株数,2005,年,22774,2006,年,33811,2007,年,36001,2008,年,36216,2009,年,43670,2010,年,47850,2011,年,59287,2012,年,72397,2013,年,84572,2014,年,78955,2015,年,88778,呼吸道,尿液,血液,伤口脓液,2021/1/5,10,CHINET,耐药监测主要菌种分布,细菌,株数,细菌,株数,大肠埃希菌,17309,19.50,草绿色链球菌,656,0.74,克雷伯菌属,12552,14.14,其他假单胞菌,388,0.44,不动杆菌属,9503,10.70,摩根菌属,386,0.43,金葡菌,8233,9.27,卡他莫拉菌,381,0.43,肠球菌属,7876,8.87,其他嗜血杆菌,150,0.17,铜绿假单胞菌,7700,8.67,拉乌尔菌属,122,0.14,凝固酶阴性葡萄球菌,4055,4.57,多源菌属,74,0.08,-,溶血性链球菌,4003,4.51,奈瑟菌属*,61,0.07,肠杆菌属,3712,4.18,志贺菌属,41,0.05,嗜麦芽窄食单胞菌,2804,3.16,产碱杆菌,34,0.04,变形杆菌属,1859,2.09,丛毛单胞菌,26,0.03,肺炎链球菌,1575,1.77,罗尔斯顿菌属,23,0.03,流感嗜血杆菌,1457,1.64,普罗威登菌属,16,0.02,沙雷菌属,959,1.08,黄杆菌属,14,0.02,伯克霍尔德菌属,935,1.05,金杆菌属,13,0.01,柠檬酸杆菌属,676,0.76,其他,510,0.57,沙门菌属,675,0.76,Total,88778,100.00,*：包括淋病奈瑟菌,52,株和脑膜炎奈瑟菌,5,株,2021/1/5,11,历年来监测的革兰阴性杆菌,(CHINET 2005-2015),（主要细菌分离率）,2005-2010,年前六位：,大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌,嗜麦芽窄食单胞菌和阴沟肠杆菌,2011,年起：,肺炎克雷伯菌和鲍曼不动杆菌排名开始上升,大肠埃希菌（,3949,）,肺炎克雷伯菌（,2136,）,鲍曼不动杆菌,（,2016,）,铜绿假单胞菌,（,2646,）,阴沟肠杆菌,（,641,）,嗜麦芽窄食单胞菌,（,1088,）,2021/1/5,12,2015,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,234/403,58.1,新疆医大一附院,158/629,25.1,瑞金医院,216/413,52.3,安徽医大一附院,268/440,60.9,协和医院,130/560,23.2,昆明医大一附院,146/435,33.6,同济医院,963/1277,75.4,中国医大一附院,136/401,33.9,广州一附院,38/97,39.2,天津医大总院,137/585,23.4,北京医院,127/180,70.6,四川大学华西医院,138/467,29.6,上海儿科医院,141/568,24.8,内蒙古医大一附院,62/21628.7,上海儿童医院,209/484,43.2,宁波龙赛医院,45/89,50.6,浙江邵逸夫医院,112/323,34.7,浦东人民医院,46/157,29.3,甘肃省人民医院,126/309,40.8,湖北秭归人民医院,45/200,22.5,总计,3477/8233,42.2,2021/1/5,13,2015,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,226,81.0,新疆医大一附院,193,88.6,瑞金医院,96,84.4,安徽医大一附院,394,84.8,协和医院,154,77.9,昆明医大一附院,220,84.5,同济医院,471,87.7,中国医大一附院,294,82.7,广州一附院,17,82.4,天津医大总院,293,77.1,北京医院,198,87.4,四川大学华西医院,208,88.0,上海儿科医院,468,83.5,内蒙古医大一附院,42,88.1,上海儿童医院,361,87.0,宁波龙赛医院,87,74.7,浙江邵逸夫医院,255,83.5,浦东人民医院,36,75.0,甘肃省人民医院,36,91.7,湖北秭归人民医院,6,66.7,合计,3411/4055,82.6,2021/1/5,14,MRSA,和,MRCNS,的检出率,(CHINET 2005-2015),2021/1/5,15,MSSA(4696,株,),与,MRSA(3477,株,),对抗菌药的耐药率（,%,）,MRSA,对抗菌药的耐药率高于,MSSA,，但除外复方磺胺甲噁唑,(7.3%Vs 14.7%),未发现万古霉素、利奈唑胺和替考拉宁耐药的菌株。,MRSA,对复方磺胺甲噁唑的耐药率较低，为,7.3%,；对其他均,40%,以上。,2021/1/5,16,MSCNS(631,株,),和,MRCNS(3411,株,),对抗菌药的耐药率（,%,）,MRCNS,对抗菌药的耐药率高于,MSCNS,发现,2,株利奈唑胺耐药菌株，但对万古霉素敏感,MRCNS,对大多抗菌药的耐药率低于,MRSA,，但复方磺胺甲噁唑反之（,56.1%VS 7.3%,）,MRCNS,对利福平的耐药率较低，为,13.8%,；对其他均近,30%,以上,2021/1/5,17,粪肠球菌,(3363,株,),和屎肠球菌,(3949,株,),对抗菌药,的耐药率（,%,）,屎肠球菌对抗菌药的耐药率高于粪肠球菌，但氯霉素反之（,26.2%Vs 3.9%,）。,102,株,VRE,中，粪肠球菌,7,株、屎肠球菌,95,株,可分型,51,株,VRE,中，,vanA 34,株（均为屎肠球菌）、,vanB 14,株（,3,株粪肠,+11,株屎肠）、,vanM 3,株（屎肠）,2021/1/5,18,溶血性链球菌对抗菌药的耐药率（,%,）,抗菌药物,A,族,（,2551,）,B,族,（,1229,）,C,族,（,137,）,G,族,（,34,）,草链,（,656,）,青霉素,0.2,1.4,5.3,6.5,9.0,红霉素,95.9,70.0,75.3,58.6,58.5,克林霉素,94.7,57.4,66.3,64.5,54.7,头孢呋辛,0.0,5.8,7.7,0.0,9.3,头孢噻肟,0.1,1.1,2.9,3.8,11.9,头孢曲松,0.1,1.7,1.8,8.3,16.3,万古霉素,0,0,0,0,0,利奈唑胺,0,0,0,0,0,左氧氟沙星,0.4,54.4,10.5,3.4,12.3,2021/1/5,19,成人和儿童医院中肺炎链球菌的分布,菌株,儿童分离株,成人分离株,2014,年,2015,年,2014,年,2015,年,株数,%,株数,%,株数,%,株数,%,PSSP,765,79.8,900,86.5,438,95.0,426,91.8,PISP,102,10.6,66,6.3,17,3.7,26,5.6,PRSP,92,9.6,75,7.2,6,1.3,12,2.6,合计,959,100.0,1041,100.0,461,100.0,464,100.0,儿童,PSSP,株比成人低，,PISP,和,PRSP,株高于成人,2021/1/5,20,儿童患者分离肺炎链球菌对抗菌药的敏感性,(%),抗菌药物,PSSP,（,900,株）,PISP,（,66,株）,PRSP,（,75,株）,耐药,敏感,耐药,敏感,耐药,敏感,青霉素,0,100,0,0,100,0,万古霉素,0,100,0,100,0,100,利奈唑胺,0,100,0,100,0,100,红霉素,95.9,1.6,100.0,0.0,100,0,克林霉素,95.0,3.8,97.0,3.0,94.7,5.3,复方磺胺甲噁唑,76.3,19.8,96.7,1.6,98.4,0.0,左氧氟沙星,0.2,99.8,0,100,0,100,莫西沙星,0.0,100.0,0,100,0,100,氯霉素,7.5,92.5,0,100,肺炎链球菌对红霉素、克林霉素和复方磺胺甲噁唑的耐药率高,2021/1/5,21,成人患者分离肺炎链球菌对抗菌药的敏感性,(%)*,抗菌药物,PSSP,（,426,株）,PISP,（,26,株）,PRSP,（,12,株）,耐药,敏感,耐药,敏感,耐药,敏感,青霉素,0,100,0,0,100.0,0.0,万古霉素,0,100,0,100,0,100.0,利奈唑胺,0,100,0,100,0,100.0,红霉素,92.5,6.3,96.2,3.8,100.0,0.0,克林霉素,89.2,9.2,88.5,11.5,1000,0.0,复方磺胺甲噁唑,64.1,24.4,100.0,0.0,100.0,0.0,左氧氟沙星,3.5,95.8,0.0,100.0,0,100.0,莫西沙星,0.7,98.7,0,100.0,0,100.0,氯霉素,13.1,86.9,0,100,0,100.0,2021/1/5,22,各医院产,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,265/610,43.4,95/635,15.0,20/82,24.1,瑞金医院316/1186,26.6,143/666,21.5,15/115,13.0,协和医院,540/1112,48.6,120/692,17.3,26/103,25.2,同济医院,799/1273,62.8,399/1111,35.9,23/79,29.1,北京医院,191/328,58.2,40/273,14.7,上海儿科医院,597/1223,48.8,241/671,35.9,上海儿童医院,309/507,60.9,186/254,73.2,浙医邵逸夫医院,575/996,57.7,129/551,23.4,20/138,14.5,甘肃省人民医院,425/714,59.5,116/366,31.7,10/39,25.6,新疆医大一附院,634/1672,37.9,273/1294,21.1,16/168,9.5,安徽医大一附院,850/1353,62.8,259/820,31.6,15/68,22.1,云南医大一附院,726/1194,60.8,410/846,48.5,15/44,34.1,中国医大一附院,380/839,45.3,151/635,23.8,40/97,41.2,天津医大总院,663/1133,58.5,346/1574,22.0,四川大学华西医院,586/978,59.9,245/865,28.3,内蒙古医科大学一附院,358/828,43.2,50/41612.0,5/45,11.1,宁波龙赛医院,135/276,48.9,66/130,50.8,5/28,17.9,浦东人民医院,195/341,57.2,70/244,28.7,22/39,56.4,湖北秭归县人民医院,192/384,50.0,32/250,12.8,4/18,22.2,合计,8736/16947,51.5,3371/12293,27.4,236/1064,22.2,2021/1/5,23,产,ESBLs,菌株的检出率,(CHINET 2005-2015),2021/1/5,24,17309,株大肠埃希菌对抗菌药的耐药率（,%,）,2021/1/5,25,产与非产,ESBLs,大肠埃希菌对抗菌药的耐药率（,%,）,抗菌药物,耐药率,抗菌药物,耐药率,产,ESBL,(8736,株,),非产,ESBL,(8211,株,),产,ESBL,(8736,株,),非产,ESBL,(8211,株,),阿米卡星,5.5,2.0,头孢哌酮,/,舒巴坦,7.9,4.6,庆大霉素,51.2,35.6,亚胺培南,1.0,1.8,哌拉西林,96.6,46.8,美罗培南,1.2,2.1,哌拉西林,/,他唑巴坦,4.6,3.3,厄他培南,1.0,2.1,头孢唑林,98.4,36.3,环丙沙星,71.9,43.3,头孢呋辛,98.6,23.2,复方磺胺甲噁唑,66.5,49.5,头孢噻肟,987,16.5,磷霉素,8.5,2.5,头孢他啶,47.0,9.9,呋喃妥因,5.3,3.6,头孢吡肟,50.8,8.3,替加环素,0.3,0.4,头孢西丁,18.8,11.9,2021/1/5,26,12552,株克雷伯菌属对抗菌药的耐药率（,%,）,（数据处理后）,2021/1/5,27,产与非产,ESBLs,克雷伯菌属对抗菌药的耐药率（,%,）（数据处理后）,抗菌药物,耐药率,抗菌药物,耐药率,产,ESBL,(3371,株,),非产,ESBL,(9124,株,),产,ESBL,(3371,株,),非产,ESBL,(9124,株,),阿米卡星,18.9,10.3,头孢哌酮,/,舒巴坦,288,18.1,庆大霉素,55.4,16.1,头孢西丁,31.1,17.4,哌拉西林,95.5,29.3,亚胺培南,16.5,14.3,哌拉西林,/,他唑巴坦,24.0,15.9,美罗培南,15.9,13.1,头孢唑林,97.5,31.1,厄他培南,11.5,11.1,头孢呋辛,97.4,29.8,环丙沙星,46.9,18.3,头孢噻肟,98.1,26.0,复方磺胺甲噁唑,62.3,16.5,头孢他啶,62.8,21.0,呋喃妥因,48.5,28.5,头孢吡肟,53.4,16.0,替加环素,6.3,4.9,2021/1/5,28,肺炎克雷伯菌对碳青霉烯类的耐药率,(CHINET 2005-2015),2021/1/5,29,1859,株变形杆菌属对抗菌药的耐药率（,%,）,2021/1/5,30,产与非产,ESBLs,奇异变形杆菌对抗菌药的耐药率（,%,）,抗菌药物,耐药率,抗菌药物,耐药率,产,ESBL,(236,株,),非产,ESBL,(1249,株,),产,ESBL,(236,株,),非产,ESBL,(1249,株,),阿米卡星,5.6,2.1,头孢哌酮,/,舒巴坦,2.6,1.2,庆大霉素,50.9,22.6,头孢西丁,7.1,1.6,哌拉西林,50.8,11.2,亚胺培南,4.9,2.3,哌拉西林,/,他唑巴坦,2.6,0.9,美罗培南,1.9,1.3,头孢唑林,97.451.7,厄他培南,2.1,2.6,头孢呋辛,96.8,23.4,环丙沙星,80.8,35.8,头孢噻肟,96.9,15.2,复方磺胺甲噁唑,86.0,52.4,头孢他啶,18.0,3.8,呋喃妥因,96.5,94.6,头孢吡肟,24.4,4.5,替加环素,15.5,5.2,2021/1/5,31,3712,株肠杆菌属细菌对抗菌药的耐药率（,%,）,2021/1/5,32,959,株沙雷菌属细菌对抗菌药的耐药率（,%,）,2021/1/5,33,676,株柠檬酸杆菌属细菌对抗菌药的耐药率（,%,）,2021/1/5,34,386,株摩根菌属细菌对抗菌药的耐药率（,%,）,2021/1/5,35,临床分离沙门菌属细菌对抗菌药的敏感性（,%,）,抗菌药物,鼠伤寒沙门菌,（,230,株）,肠炎沙门菌,（,187,株）,副伤寒沙门菌,（,48,株）,伤寒沙门菌,（,27,株）,耐药,敏感,耐药,敏感,耐药,敏感,耐药,敏感,氨苄西林,73.5,25.7,75.3,23.7,20.0,77.8,62.5,33.3,氨苄西林,/,舒巴坦,16.4,54.2,28.6,35.7,6.2,90.6,21.4,64.3,阿莫西林,/,克拉维酸,24.0,62.0,18.7,64.8,6.7,80.0,0,70.0,头孢哌酮,/,舒巴坦,0.0,93.1,0.0,87.0,0.0,90.9,0,100,头孢曲松,12.9,86.2,15.7,84.3,2.2,97.8,16.0,84.0,环丙沙星,0.9,92.1,0.0,97.3,0,93.6,7.7,92.3,复方磺胺甲噁唑,24.7,74.4,8.6,88.2,8.0,92.0,20.0,80.0,氯霉素,28.1,70.5,11.0,87.7,7.4,92.6,10.0,90.0,2021/1/5,36,38421,株肠杆菌科细菌对抗菌药的耐药率（,%,）,抗菌药物,耐药,敏感,替加环素,3.0,81.1,厄他培南,5.5,91.7,阿米卡星,6.5,92.2,亚胺培南,7.2,90.7,美罗培南,8.0,91.4,哌拉西林,/他唑巴坦,9.3,84.8,头孢哌酮,/,舒巴坦,11.4,76.6,头孢吡肟,24.8,66.2,头孢他啶,28.7,67.3,庆大霉素,32.4,66.2,环丙沙星,38.5,58.0,2021/1/5,37,7700,株铜绿假单胞菌对抗菌药的耐药率（,%,）,2021/1/5,38,9503,株不动杆菌属,(,鲍曼不动,93.4%),对抗菌药的耐药率（,%,）,2021/1/5,39,嗜麦芽窄食单胞菌和伯克霍尔德菌属对抗菌药的耐药率（,%,）,抗菌药物,嗜麦芽窄食单胞菌（,2804,株）,抗菌药物,伯克霍尔德菌属（,935,株）,耐药,敏感,耐药,敏感,头孢哌酮,/,舒巴坦,23.7,49.1,替卡西林,/,克拉维酸,82.6,13.0,左氧氟沙星,9.0,87.2,头孢他啶,7.7,87.2,复方磺胺甲噁唑,7.0,92.0,美罗培南,12.4,82.0,米诺环素,2.1,93.1,复方磺胺甲噁唑,4.4,94.8,氯霉素,11.3,58.5,米诺环素,4.5,81.4,头孢他啶,36.4,53.8,左氧氟沙星,12.3,70.3,替卡西林,/,克拉维酸,26.9,51.3,2021/1/5,40,21841,株不发酵糖菌对抗菌药的耐药率（,%,）,抗菌药物,耐药,敏感,头孢哌酮,/,舒巴坦,27.9,54.2,阿米卡星,28.2,69.2,哌拉西林,/,他唑巴坦,37.8,53.6,头孢他啶,41.3,53.0,环丙沙星,41.6,54.5,头孢吡肟,44.5,44.4,美罗培南,43.8,53.6,亚胺培南,47.5,49.2,2021/1/5,41,流感嗜血杆菌对抗菌药的耐药率,(%),抗菌药物,儿童株（,861,株）,成人株（,595,株）,耐药,敏感,耐药,敏感,氨苄西林,49.1,41.1,35.5,57.7,阿莫西林,/,克拉维酸,31.2,68.8,26.3,73.7,氨苄西林,/,舒巴坦,25.9,74.1,16.5,83.5,头孢呋辛,26.7,67.6,14.2,82.1,头孢曲松,6.1*,93.9,6.6*,93.4,氯霉素,7.0,85.8,9.4,85.7,阿奇霉素,17.1*,82.9,10.9*,89.1,左氧氟沙星,0.4*,99.4,3.2*,95.1,复方磺胺甲噁唑,68.2,29.9,52.9,44.5,儿童株产酶率：,38.0%,，成人株产酶率：,33.5%,（总产酶率：,36.4%,）,*:,非敏感率,2021/1/5,42,克雷伯菌属对亚胺培南和美罗培南的耐药率,医院,株数,亚胺培南,株数,美罗培南,耐药,敏感,耐药,敏感,宁波龙赛医院,131,0.8,99.2,131,0.8,99.2,湖北秭归县人民医院,258,1.2,98.4,258,1.2,98.8,天津医大总院,1586,1.5,98.2,浦东人民医院,244,2,96.7,244,2.5,95.5,甘肃省人民医院,363,2.8,95.9,365,1.6,97,四川大学华西医院,862,3.9,95.2,7,100,0,新疆医大一附院,1271,3.9,95.1,397,2.3,96.2,内蒙医大一附院,419,4.3,95.2,182,5.5,94,中国医大一附院,502,7.8,91.8,496,7.5,92.5,广州医大一附院,201,9,91,119,7.6,92.4,北京协和医院,620,10.3,89.7,684,9.8,90.2,安徽医大一附院,825,14.5,82.5,571,18.9,79.2,上海瑞金医院666,20.7,75.2,318,22.6,75.5,上海儿科医院,662,24.9,73.6,665,27.1,70.8,昆明医大一附院,812,26.2,72.4,844,25.9,73.5,浙江邵逸夫医院,563,26.3,68.7,429,22.4,76.7,上海儿童医院,254,27.2,69.3,254,27.6,71.7,卫生部北京医院,275,29.8,69.5,275,30.2,69.1,湖北同济医院,1067,34.6,65.1,1064,34.7,65.1,上海华山医院,635,39.5,57,556,37.6,60.4,2021/1/5,43,铜绿假单胞菌对亚胺培南和美罗培南的耐药率,医院,株数,亚胺培南,株数,美罗培南,耐药,敏感,耐药,敏感,浦东人民医院,128,9.4,88.3,128,5.5,87.5,宁波龙赛医院,95,10.5,83.2,95,8.4,87.4,甘肃省人民医院,172,11,87.2,172,9.9,86.6,上海儿童医院,89,11.2,86.5,90,11.1,86.7,上海儿科医院,195,11.3,84.6,227,7.5,89.9,湖北秭归县人民医院,130,11.5,87.7,127,11,85.8,新疆医大一附院,600,12,81.7,592,10.5,86.7,北京协和医院,635,16.5,81.9,63711.9,84.9,天津医大总院,801,23.5,69.9,广州医大一附院,275,23.6,70.5,254,20.9,77.6,安徽医大一附院,460,27.6,65.7,343,21.9,72.3,中国医大一附院,392,28.8,64.3,393,23.7,70.5,浙江邵逸夫医院,437,29.1,66.1,346,22,74,内蒙医大一附院,199,29.6,61.3,138,27.5,66.7,昆明医大一附院,217,31.3,63.6,225,28,67.1,四川大学华西医院,698,33,62.2,88,44.3,50,卫生部北京医院,320,37.8,59.1,319,31.3,63,湖北同济医院,780,39.2,57.9,780,36.2,60.5,上海瑞金医院,371,45,51.2,312,33,61.2,上海华山医院,458,48.3,46.7,432,46.5,48.6,2021/1/5,44,不动杆菌属对亚胺培南和美罗培南的耐药率,医院,株数,亚胺培南,株数,美罗培南,耐药,敏感,耐药,敏感,宁波龙赛医院,40,7.5,90,40,10,90,浦东人民医院,94,18.1,79.8,94,21.3,77.7,天津医大总院,1310,21.8,77.8,内蒙医大一附院,222,41.4,55,34,52.9,44.1,上海儿科医院,273,51.6,48,274,52.2,47.8,上海儿童医院,182,51.6,46.7,182,52.2,47.8,湖北秭归县人民医院,80,52.5,43.8,80,51.2,48.8,广州医大一附院,134,53,46.3,71,64.8,35.2,新疆医大一附院,835,60.6,39.2,7,14.3,85.7,上海瑞金医院,456,61.8,37.5,232,65.1,34.9,卫生部北京医院,205,63.4,36.6,205,63.4,36.6,上海华山医院,543,69.8,29.8,473,69.8,30,昆明医大一附院,396,71,29,221,76,24,四川大学华西医院,864,71.1,28.7,19,10.5,5.3,北京协和医院,564,72.2,27,588,70.9,28.4,中国医大一附院,430,74,25.8,12,75,25,安徽医大一附院,515,75,22.9,457,75.1,24.7,甘肃省人民医院,248,75,24.6,249,73.5,26.1,浙江邵逸夫医院,509,76.6,23.2,368,74.2,25.5,湖北同济医院,1249,83.8,15.7,1250,83.8,15.6,2021/1/5,45,各医院广泛耐药株的检出率,医院,肺炎克雷伯菌,鲍曼不动杆菌,铜绿假单胞菌,XDR,株数,/,总株数,（）,XDR,株数,/总株数,（）,XDR,株数,/,总株数,（）,宁波龙赛医院,0/120,0.0,0/40,0.0,0/95,0.0,浦东人民医院,2/213,0.9,9/92,9.8,0/128,0.0,天津医大总院,0/1443,0.0,90/1034,8.7,0/804,0.0,内蒙医大一附院,1/364,0.3,77/204,37.7,0/202,0.0,上海儿科医院,3/637,0.5,30/259,11.6,1/227,0.4,上海儿童医院,7/246,2.8,5/170,2.9,0/90,0.0,湖北秭归县人民医院,2/225,0.9,29/72,40.3,2/130,1.5,广州医大一附院,3/187,1.6,45/126,35.7,1/275,0.4,新疆医大一附院,4/1167,0.3,7/832,0.8,3/632,0.5,上海瑞金医院,70/635,11.0,93/444,20.9,17/371,4.6,卫生部北京医院,13/261,5.0,79/199,39.7,10/320,3.1,上海华山医院,130/621,20.9,220/518,42.5,20/459,4.4,昆明医大一附院,1/805,0.1,27/411,6.6,14/227,6.2,四川大学华西医院,1/805,0.1,191/853,22.4,29/708,4.1,北京协和医院,19/630,3.0,102/553,18.4,9/650,1.4,中国医大一附院,14/599,2.3,21/537,3.9,2/522,0.4,安徽医大一附院,17/667,2.5,36/585,6.1,9/465,1.9,甘肃省人民医院,0/306,0.0,62/241,25.7,2/174,1.1,浙江邵逸夫医院,66/542,12.2,124/496,25.0,2/440,0.5,湖北同济医院,74/1059,7.0,500/1209,41.4,12/781,1.5,合计,427/11532,3.7,1747/8875,19.68,133/7700,1.7,2014,336/10360,3.24,1606/8157,19.69,119/7471,1.6,2021/1/5,46,小结,替加环素对革兰阴性杆菌的耐药率较低,肺炎克雷伯菌对碳青霉烯类的耐药率仍稳步上升,3,家二级医院分离的革兰阴性杆菌对碳青霉烯类的耐药率低于多数三级医院,肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌,泛耐药菌株的检出率亦如此,2021/1/5,47,2021/1/5,48,谢谢！,