o09耐药检测.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Zhu_dm,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,*,*,*,*,zhu_dm,中国,CHINET,_,革兰阴性菌的,耐药性监测,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,安徽医大一附院,昆明医学院一附院,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,细菌耐药性已成为全球医疗领域中最受关注的问题,建立细菌耐药性监测网是,WHO,“,抑制细菌耐药性的全球性策略,”,中国,CHINET,耐药性监测网成立于,2004,年,10,月涉及北京、上海、杭州、广州、武汉、重庆等,6,个城市的,8,所三级甲等医院（教学医院）,2006,年发展到,12,家（,2,所儿童医院，以及新疆和甘肃的,2,所）,2009,年发展到,14,家（昆明和安徽的,2,所）,按统一方法（,K-B,法）、标准化的材料进行动态性耐药性监测,CHINET,监测网 历年来监测的菌株数,年份,参加实验室,监测株数,革兰阴性菌,（,%,）,革兰阳性菌,（,%,）,2005,年,8,22774,15244,66.9,7530,33.1,2006,年,12,33811,23062,68.2,10749,31.8,2007,年,12,36001,23637,65.7,12364,34.3,2008,年,12,36216,25184,69.5,11032,30.5,2009,年,14,43670,31002,71.0,12668,29.0,合计,172472,118129,68.5,54343,31.5,2009,年,CHINET 43670,株细菌分布情况,87.5%,12.5,71.0,29.0,53.8,39.9,6.4,1.2,5.4,20.5,29.8,32.5,7.9,2008-CHINET,资料,2009,年,CHINET,监测网,临床分离菌在各类标本中的分布,呼吸道标本,（,49.7,）,尿液标本,（,19.9,）,血液标本,（,10.8,）,伤口脓液（,5.3,）,无菌体液（,4.8,）,生殖道分泌物（,1.7,）,粪便标本（,0.6,）,其他（,7.2,）,细 菌,检出率,%,2009,年,CHINET 43670,株临床分离株中前十位细菌,2008-CHINET,资料,细菌,总株数,检出菌株数,检出率范围,平均检出率,大肠埃希菌,7992,4515,33.3-78.5,56.5,肺克和产酸,4933,2041,21.7-70.8,41.4,奇异变形杆菌,693,111,0.0-33.3,16.0,2009,年,CHINET,产,ESBLs,菌株检出率,大肠埃希菌的耐药率（,%,）,(CHINET 2009),产,ESBL,株对,内酰胺类和其他测试药的耐药率高于非产酶株,对,FQ,、庆大霉素、哌拉西林的耐药率极高（,60%,）,对碳青霉烯类、两种酶抑制剂复方的耐药率低,克雷伯菌属的耐药率（,%,）,(CHINET 2009),产,ESBL,株对,内酰胺类、,FQ,、氨基糖苷类、磺胺类的耐药率比非产,ESBL,株高，,对碳青霉烯类耐药率较,2008,年高,奇异变形杆菌的耐药率（,%,）,(CHINET 2009),产,ESBL,株对,内酰胺类和其他测试药的耐药率高于非产酶株,对,FQ,、庆大霉素、哌拉西林的耐药率极高（,60%,）,对碳青霉烯类、两种酶抑制剂复方的耐药率低,肠杆菌属（,1684,株）,柠檬酸杆菌属（,345,株）,摩根菌属,(146,株,),沙雷菌属,(389,株,),其他肠杆菌科细菌的耐药率,(%)(CHINET 2009),对碳青霉烯类的耐药率低（,2%,）,对阿米卡星、头孢吡肟、两种酶抑制剂复方的耐药率,20%,对碳青霉烯类的耐药率低,(,6%),对两种酶抑制剂复方、头孢吡肟、阿米卡星的耐药率,20%,对碳青霉烯类耐药率低,(,2%),、两种酶抑制剂复方、头孢吡肟、阿米卡星,的耐药率,5%,，对,第三代头孢菌素的耐药率为,10%,左右,对碳青霉烯类的耐药率低,(,2%),两种酶抑制剂复方的耐药率,5%,FQ,、第,3,、,4,代头孢菌素、阿米卡星和,TMP/SMZ,的耐药率,20%,2009,年,14,家医院,16750,株肠杆菌科细菌耐药率（,%,）,抗菌药物,耐药,敏感,亚胺培南,1.3,98.4,美罗培南,1.3,98.5,厄他培南,2.4,96.7,头孢哌酮,/,舒巴坦,7.5,77.1,哌拉西林,/,他唑巴坦,9.2,80.0,阿米卡星,10.5,86.5,头孢他啶,22.7,70.8,头孢吡肟,20.2,70.8,庆大霉素,42.0,56.0,肠杆菌科细菌除对三种碳青霉烯类的耐药率略有增加外,(2008,1%),，,与,2008,年的结果基本相仿,2009,年,14,家医院,4912,株铜绿假单胞菌耐药率（,%,）,亚胺培南,美罗培南,铜绿假单胞菌对所测试药物的敏感率与耐药率与,2008,年基本相仿，对亚胺培南、美罗培南的耐药率分别为,30.5%,和,25.2%,，对其他测试药物的耐药率均在,15-30%,间,2009,年,14,家医院,4796,株不动杆菌属,(,鲍曼不动,86.8%),细菌的耐药率（,%,）,头孢哌酮,/,舒巴坦的耐药率略上升（,14.6%,vs,24%,），对其他药物耐药率高（,50%,）,两种碳青霉烯类的耐药率均,50%,或以上,亚胺培南,美罗培南,2009,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（,1656,株）,抗菌药物,伯克霍尔德菌属（,304,株）,耐药,敏感,耐药,敏感,头孢哌酮,/,舒巴坦,15.1,62.2,哌拉西林,/,他唑巴坦,13.9,77.6,左氧氟沙星,12.4,83.1,头孢他啶,11.1,86.5,复方磺胺甲噁唑,13.2,83.0,美罗培南,12.3,84.8,米诺环素,1.8,83.5,复方磺胺甲噁唑,16.8,74.5,米诺环素,11.6,78.3,嗜麦芽窄食单胞菌对,CLSI,推荐的,TMP/SMZ,、米诺环素、左氧氟沙星敏感率均在,80%,以上，对头孢哌酮,/,舒巴坦耐药率亦较低，但中介株较多，敏感率仅,62%,伯克霍尔德菌对,CLSI,推荐的米诺环素和,TMP/SMZ,的耐药率与,2008,年资料相比均有所增加，敏感率有所减低；对头孢他啶和美罗培南的耐药率仍在,80%,以上，对哌拉西林,/,他唑巴坦的耐药率亦较低，敏感率为,77.6%,2009,年,14,家医院,12823,株非发酵菌耐药率（,%,）,抗菌药物,耐药,敏感,头孢哌酮,/,舒巴坦,20.5,58.3,美罗培南,41.3,56.0,阿米卡星,36.3,59.8,头孢他啶,36.4,57.6,头孢吡肟,37.6,54.5,哌拉西林,/,他唑巴坦,39.0,55.9,亚胺培南,44.4,52.9,环丙沙星,40.0,53.0,与,2008,年的结果相比，细菌对头孢哌酮,/,舒巴坦的耐药率略见增高，敏感率略有下降，其余基本相仿,(,敏感率在,50%-59%,之间,),CHINET,各医院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,美罗培南,耐药,敏感,耐药,敏感,上海儿童医院,97,18.6,78.4,17.7,79.2,广州医大一附院,322,21.6,75.6,16.3,81.8,重庆医大一附院,167,13.8,77.8,12.0,79.0,上海儿科医院,192,6.8,91.1,6.8,91.6,卫生部北京医院,467,49.5,46.5,43.7,49.7,上海华山医院,850,42.4,52.5,31.1,60.3,北京协和医院,474,23.9,74.6,16.1,80.8,甘肃省人民医院,131,8.4,91.6,7.6,90.8,上海瑞金医院,331,21.9,74.2,18.5,76.6,湖北同济医院,488,20.7,77.8,11.7,85.0,浙医一附院,606,29.6,69.3,25.2,72.7,新疆医大一附院,122,25.8,70.0,26.7,68.3,安徽医大一附院,308,30.1,65.4,42.3,53.8,昆明医大一附院,357,61.3,34.0,56.7,35.2,儿科、儿童、甘肃耐药率低（,20%,）较前年上升：北京医院、新疆,较去年下降：重医、北京协和、瑞金,昆明：耐药率最高,CHINET,各医院,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,美罗培南,耐药,敏感,耐药,敏感,上海儿童医院,136,35.6,61.5,28.9,69.6,广州医大一附院,231,29.4,67.5,30.4,67.0,重庆医大一附院,289,47.4,51.6,47.6,52.1,上海儿科医院,137,20.7,72.6,33.3,64.4,卫生部北京医院,126,41.3,53.2,50.8,48.4,上海华山医院,640,55.0,43.8,56.3,42.9,北京协和医院,526,65.4,32.5,68.7,30.3,甘肃省人民医院,123,20.3,79.7,20.3,79.7,上海瑞金医院,448,45.5,54.0,45.8,53.5,湖北同济医院,686,52.5,46.2,53.4,46.1,浙医一附院,802,66.5,32.7,68.5,31.3,新疆医大一附院,130,32.5,62.7,42.7,54.8,安徽医大一附院,304,38.0,56.0,47.3,51.6,昆明医大一附院,181,43.5,55.7,32.7,65.5,各院耐药率均有不同程度上升,浙医位居首位，耐药率保持不变,2009,年各医院泛耐药株数,医院,铜绿假单胞菌,鲍曼不动杆菌,总株数,（）,总株数,（）,华山医院,9,1.1,118,19.6,瑞金医院,13,3.9,60,14.0,协和医院,4,0.8,213,42.2,同济医院,7,1.4,23,5.4,浙医一附院,12,2.0,200,27.0,广州一附院,0,0.0,18,9.5,重医一附院,6,3.6,6,2.3,北京医院,14,3.0,27,27.3,儿科医院,0,0.0,0,0.0,儿童医院,1,1.0,16,11.8,甘肃人民医院,0,0.0,5,4.1,新疆医大一附院,0,0.0,0,0.0,安徽医大一附院,12,3.9,23,9.7,昆明医大一附院,7,2.0,0,0.0,合计,85/4867,1.7,709/4163,17.0,2008,年,85/4130,2.1,340/3120,10.9,革兰阴性杆菌中对全部测试的抗菌药,(,除多黏菌素和黏菌素外,),均耐药的泛耐药株仍存在,2009,年各医院泛耐药株数,医院,肺炎克雷伯菌,弗劳地柠檬酸杆菌,PDR,株数总株数,PDR,（）,PDR,株数总株数,PDR,（）,华山医院,71,11.1,6,33.3,瑞金医院,0,0.0,0,0.0,协和医院,0,0.0,0,0.0,同济医院,0,0.0,0,0.0,浙医一附院,8,1.4,1,2.7,广州一附院,0,0.0,0,0.0,重医一附院,2,1.2,0,0.0,北京医院,0,0.0,0,0.0,儿科医院,0,0.0,0,0.0,儿童医院,0,0.0,0,0.0,甘肃,0,0.0,0,0.0,新疆医大一附院,0,0.0,0,0.0,安徽医大一附院,0,0.0,0,0.0,昆明医大一附院,0,0.0,0,0.0,合计,81/4470,1.8,7/263,2.7,2008,年,10/3078,0.3,13/222,5.9,小结,209,年共收集临床分离菌,43670,株绝大多数（,87.5%,）自住院患者中分离，其余自门诊患者中分离。,43670,分离菌中革兰阳性菌占,29%,，革兰阴性菌占,71%,。,小结,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,ESBLs,株分别平均为,56.5%,和,41.4%,；奇异变形杆菌中产,ESBLs,株的检出率为,16%,产,ESBLs,株对测试药的耐药率比非产酶株高，但非产酶株对碳青霉烯类耐药率菌高于产酶株，推测可能部分菌株除产,ESBLs,外，同时产,AmpC,等其他,-,内酰胺酶，致使,ESBLs,检测结果呈阴性，即实际上非产酶株中包含了部分,ESBLs,株,肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感，总耐药率,2%,，较,2008,年（,1%,）略有增加,小结,铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为,30.5%,和,25.2%;,鲍曼不动杆菌对两者的耐药率均已超过,50%,。糖不发酵革兰阴性杆菌对测试抗菌药的耐药率除头孢哌酮,/,舒巴坦（,20.5%,）外，在,36%-44%,，敏感率在,50%-59%,。提示单药治疗此类细菌所致全身性感染，疗效可能不够满意。,与,2008,年相比，肺炎克雷伯菌,(1.8%VS 0.3%),和鲍曼不动杆菌,(17.0%VS10.9%),中的泛耐药株显著增多，,细菌耐药性仍呈增长趋势，尤其泛耐药革兰阴性杆菌感染监测和防治已成为临床面临的最严重的挑战,THANK YOU,！,CHINET,监测,