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2007-2018 年中国抗菌药物耐药监测试验计划中耐碳青霉烯类抗菌药物的耐药性分析。

Analysis of the Drug Resistance of Carbapenem-Resistant in the China Antimicrobial Resistance Surveillance Trial Program, 2007-2018.

机构信息

Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China.

出版信息

Microb Drug Resist. 2020 Aug;26(8):944-950. doi: 10.1089/mdr.2019.0299. Epub 2020 Feb 11.

Abstract

To analyze the drug resistance data of carbapenem-resistant (CRKP) collected in 19 tertiary hospitals in the China Antimicrobial Resistance Surveillance Trial Program from 2007 to 2018. According to the unified plan, clinical isolates of were collected from 19 tertiary hospitals in 19 cities in mainland China. The minimum inhibitory concentrations (MIC) were determined by a twofold agar dilution method, and antimicrobial susceptibility was established. The isolates were characterized by antimicrobial susceptibility testing, and their drug resistance data were analyzed. In total, 302 strains of CRKP were screened from 3,671 strains of . The clinical isolation rate of CRKP increased from 0.9% to 19.9% in the past 12 years, and the isolation rate of CRKP in pediatric patients increased the fastest, to 24.7%. Along this period, the isolation rate in the intensive care unit was higher than that in other settings. The number of CRKP strains with imipenem and meropenem MIC ≤8 mg/L decreased from 63.6% to 11.7% and from 72.7% to 14.2%, respectively. Resistance to drugs that may be used to treat drug-resistant bacterial infections has increased to varying degrees, and CRKP has the lowest resistance rate to polymyxin B (<19.0%). Because the MIC of CRKP is increasing each year in China, carbapenems are less likely to be used as part of combined therapy to treat CRKP infections. It is difficult to obtain good therapeutic effects against CRKP infections with MICs that are too high. CRKP is still the most sensitive to polymyxin B , followed by tigecycline. Combination therapy may be the most effective current treatment for CRKP infection.

摘要

对 2007 年至 2018 年中国抗菌药物监测网 19 家三级医院收集的碳青霉烯类耐药(CRKP)耐药数据进行分析。按照统一方案,从中国大陆 19 个城市的 19 家三级医院收集 临床分离株。采用二倍琼脂稀释法测定最低抑菌浓度(MIC),并进行抗菌药物敏感性试验,对分离株进行抗菌药物敏感性试验鉴定,并对其耐药数据进行分析。共从 3671 株 中筛选出 302 株 CRKP。12 年来,CRKP 的临床分离率从 0.9%上升到 19.9%,儿科患者的分离率上升最快,达到 24.7%。在此期间,重症监护病房(ICU)的分离率高于其他环境。亚胺培南和美罗培南 MIC≤8mg/L 的 CRKP 菌株数量分别从 63.6%下降到 11.7%和从 72.7%下降到 14.2%。治疗耐药菌感染的药物耐药性呈不同程度增加,CRKP 对多黏菌素 B 的耐药率最低(<19.0%)。由于中国 CRKP 的 MIC 每年都在增加,碳青霉烯类药物不太可能被用作治疗 CRKP 感染的联合治疗的一部分。对于 MIC 过高的 CRKP 感染,很难获得良好的治疗效果。CRKP 对多黏菌素 B 的敏感性最高,其次是替加环素。联合治疗可能是目前治疗 CRKP 感染最有效的方法。

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