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（,