日本全国临床分离株中氟喹诺酮类药物和其他抗菌药物敏感性趋势的调查：1994 年至 2016 年的纵向分析。

Investigation of the susceptibility trends in Japan to fluoroquinolones and other antimicrobial agents in a nationwide collection of clinical isolates: A longitudinal analysis from 1994 to 2016.

机构信息

Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan; Department of Clinical Laboratory, Toho University Omori Medical Center, Japan.

Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan.

出版信息

J Infect Chemother. 2019 Aug;25(8):594-604. doi: 10.1016/j.jiac.2019.03.008. Epub 2019 Apr 3.

DOI:10.1016/j.jiac.2019.03.008

PMID:30954447

Abstract

The susceptibilities of clinical isolates to fluoroquinolones and other antimicrobial agents were surveyed to obtain an accurate understanding of trends in incidence and antimicrobial resistance. The samples were collected from across Japan, biennially or triennially, between 1994 and 2016 and a defined level of resistance to fluoroquinolone was determined. Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae exhibited stable and high rates of susceptibility to fluoroquinolones over the period examined. For methicillin-resistant Staphylococcus aureus the rate of resistance to levofloxacin and ciprofloxacin was 81.3-93.5% and 83.2-94.2%, respectively, which was markedly higher than that of methicillin-susceptible S. aureus, while sitafloxacin-resistant methicillin-susceptible and methicillin-resistant S. aureus were isolated at 0.3-0.7% and 16.9-36.5%, respectively. The rate of levofloxacin or ciprofloxacin-resistant Escherichia coli increased from around 2-3% between 1994 and 1998 to around 35% in 2016, but the rate of fluoroquinolone-susceptible Klebsiella pneumoniae stayed high at over 94.6% during the study period. Although no fluoroquinolone-resistance in clinical isolates of Salmonella spp. was detected from 1994 to 2002, the resistance rate increased slightly after 2004 and reached to 1.9%-4.7% in 2016. The rate of fluoroquinolone-susceptible Pseudomonas aeruginosa isolated from urinary tract and respiratory tract infections improved during the period examined from 41.8-67.0% to 91.2-94.2%, and from 78.9-88.5% to 90.1-94.6%, respectively. Against Acinetobacter spp., the susceptibility rate of fluoroquinolones was almost constant at around 90%, but one multidrug-resistant isolate was detected in 2013. Overall, the susceptibility to fluoroquinolones was maintained over 20 years against tested bacteria except for MRSA and E. coli.

摘要

为了准确了解发病率和抗菌药物耐药性的趋势，我们调查了临床分离株对氟喹诺酮类药物和其他抗菌药物的敏感性。这些样本是在 1994 年至 2016 年间，每隔两年或三年从日本各地收集的，并确定了对氟喹诺酮类药物的耐药水平。在研究期间，肺炎链球菌、化脓性链球菌和流感嗜血杆菌对氟喹诺酮类药物的敏感性一直保持稳定且较高。耐甲氧西林金黄色葡萄球菌对左氧氟沙星和环丙沙星的耐药率分别为 81.3-93.5%和 83.2-94.2%，明显高于甲氧西林敏感金黄色葡萄球菌，而对司帕沙星耐药的甲氧西林敏感和耐甲氧西林金黄色葡萄球菌的分离率分别为 0.3-0.7%和 16.9-36.5%。左氧氟沙星或环丙沙星耐药大肠埃希菌的耐药率从 1994 年至 1998 年的 2-3%左右上升到 2016 年的 35%左右，但研究期间，氟喹诺酮敏感肺炎克雷伯菌的耐药率仍保持在 94.6%以上。虽然 1994 年至 2002 年未检测到临床分离的沙门氏菌属对氟喹诺酮类药物的耐药性，但 2004 年后耐药率略有上升，2016 年达到 1.9%-4.7%。在研究期间，从尿路感染和呼吸道感染中分离出的对氟喹诺酮类药物敏感的铜绿假单胞菌的比例从 41.8-67.0%提高到 91.2-94.2%，从 78.9-88.5%提高到 90.1-94.6%。对不动杆菌属，氟喹诺酮类药物的敏感性几乎保持在 90%左右，但在 2013 年检测到了一个多药耐药株。总的来说，除了耐甲氧西林金黄色葡萄球菌和大肠埃希菌外，20 年来，测试细菌对氟喹诺酮类药物的敏感性一直保持稳定。