Tang Xiang, Xiao Meng, Zhuo Chao, Xu Yingchun, Zhong Nanshan
State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China.
Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing 100000, China.
J Thorac Dis. 2018 May;10(5):2666-2675. doi: 10.21037/jtd.2018.04.46.
With the different situation for clinical antibiotic usage and its management in different regions and medical institutions, the antimicrobial resistance varied in different level. However, the epidemiological data of multi-drug resistant (MDR) strains from the department of respiration is limited. Thus, this study aims to investigate the epidemiology of bacteria isolated from inpatients of respiratory departments, and analyze the distribution variation of major multi-drug resistant bacteria in China.
Based on data from China Antimicrobial Resistance Surveillance System (CARSS) in 2015, 50,417 non-duplicate isolates obtained from inpatients of respiratory departments from 91 general hospitals in seven regions of China were enrolled in the study. The distribution of methicillin-resistant (MRSA), carbapenem-resistant (CREC) and (CRKP), carbapenem-resistant (CRPA) and (CRAB), extended-spectrum β-lactamases-producing (ESBL-EC) and (ESBL-KP), were further analyzed by geographic regions, age groups, wards and specimen types.
The major specimens type were sputum (81.6%, 41,131/50,417), followed by blood (5.3%, 2,649/50,417), urine (4.5%, 2,249/50,417) and bronchoalveolar lavage fluid (BALF) (3.2%, 1,620/50,417). The top four bacteria species isolated from sputum and BALF were similar: (18.9% and 14.8%, respectively), (13.6% and 22.2%, respectively), (11.3% and 11.9%, respectively) and (11.1% and 9.6%, respectively). The four most common bacteria species were (17.2%), (12.1%), (10.4%) and (10.1%) in tertiary hospitals but (20.8%), (16.3%), (11.3%) and (6.9%) in secondary hospitals. The top four bacteria species in respiratory intensive care unit (RICU) were (25.8%), (13.1%), (12.2%) and (9.2%). The prevalence of CRKP, CRPA and CRAB in tertiary hospitals was significantly higher than that in secondary hospitals (5.2% 2.5%, 23.8% 12.8% and 53.5% 33.9%, respectively) (all P<0.05). However, the prevalence of ESBL-EC in secondary hospitals was higher than in tertiary ones (63.9% . 55.0%, P=0.011). The prevalence of MRSA, CRKP, CRAB, CRPA, ESBL-EC, ESBL-KP in RICU were higher than that in non-ICU respiratory departments (76.5% . 35.7%, 20.1% . 4.1%, 90.6% . 45.5%, 64.2% 19.3%, 47.2% . 28.3% and 43.0% . 11.2%, respectively) (all P<0.01). Among seven regions in China, central area had the highest detection rates of MRSA (70.3%, 237/337), CRPA (30.9%, 376/1,218), CRAB (71.8%, 487/678) and ESBL-KP (38.8%, 241/621). The prevalence of ESBL-EC and ESBL-KP in pediatric group (68.2% and 55.3%, respectively) was higher than that in geriatric group (54.2% and 27.1%, respectively) and adult group (51.1% and 15.1%, respectively) (all P<0.001).
In China, the predominant bacterial pathogens in the respiratory ward were and non-fermentative bacteria. High prevalence of ESBL-EC and ESBL-KP isolated from lower respiratory tract (LRT) was revealed in primary hospitals and pediatric patients.
由于不同地区和医疗机构临床抗生素使用及其管理情况各异，抗菌药物耐药性存在不同程度的差异。然而，呼吸科多药耐药（MDR）菌株的流行病学数据有限。因此，本研究旨在调查呼吸科住院患者分离出的细菌的流行病学情况，并分析中国主要多药耐药菌的分布变化。
基于2015年中国抗菌药物耐药监测系统（CARSS）的数据，纳入了来自中国七个地区91家综合医院呼吸科住院患者的50417株非重复分离株。进一步按地理区域、年龄组、病房和标本类型分析耐甲氧西林金黄色葡萄球菌（MRSA）、耐碳青霉烯类大肠埃希菌（CREC）和肺炎克雷伯菌（CRKP）、耐碳青霉烯类铜绿假单胞菌（CRPA）和鲍曼不动杆菌（CRAB）、产超广谱β-内酰胺酶大肠埃希菌（ESBL-EC）和肺炎克雷伯菌（ESBL-KP）的分布情况。
主要标本类型为痰液（81.6%，41131/50417），其次为血液（5.3%，2649/50417）、尿液（4.5%，2249/50417）和支气管肺泡灌洗液（BALF）（3.2%，1620/50417）。从痰液和BALF中分离出的前四种细菌种类相似：肺炎克雷伯菌（分别为18.9%和14.8%）、铜绿假单胞菌（分别为13.6%和22.2%）、鲍曼不动杆菌（分别为11.3%和11.9%）和金黄色葡萄球菌（分别为11.1%和9.6%）。三级医院中四种最常见的细菌种类为肺炎克雷伯菌（17.2%）、铜绿假单胞菌（12.1%）、鲍曼不动杆菌（10.4%）和金黄色葡萄球菌（10.1%），而二级医院中为肺炎克雷伯菌（20.8%）、大肠埃希菌（16.3%）、铜绿假单胞菌（11.3%）和鲍曼不动杆菌（6.9%）。呼吸重症监护病房（RICU）中前四种细菌种类为鲍曼不动杆菌（25.8%）、铜绿假单胞菌（13.1%）、肺炎克雷伯菌（12.2%）和金黄色葡萄球菌（9.2%）。三级医院中CRKP、CRPA和CRAB的患病率显著高于二级医院（分别为5.2%对2.5%、23.8%对12.8%和53.5%对33.9%）（均P<0.05）。然而，二级医院中ESBL-EC的患病率高于三级医院（63.9%对55.0%，P=0.011）。RICU中MRSA、CRKP、CRAB、CRPA、ESBL-EC、ESBL-KP的患病率高于非ICU呼吸科（分别为76.5%对35.7%、20.1%对4.1%、90.6%对45.5%、64.2%对19.3%、47.2%对28.3%和43.0%对11.2%）（均P<0.01）。在中国七个地区中，中部地区MRSA（70.3%，237/337）、CRPA（30.9%，376/1218）、CRAB（71.8%，487/678）和ESBL-KP（38.8%，241/621）的检出率最高。儿科组中ESBL-EC和ESBL-KP的患病率高于老年组（分别为68.2%和55.3%）和成人组（分别为51.1%和15.1%）（均P<0.001）。
在中国，呼吸病房中主要的细菌病原体为肺炎克雷伯菌和非发酵菌。基层医院和儿科患者下呼吸道分离出的ESBL-EC和ESBL-KP患病率较高。
