State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
Antimicrob Resist Infect Control. 2022 Jan 24;11(1):17. doi: 10.1186/s13756-022-01055-5.
In this first national bloodstream infection (BSI) surveillance program in China, we assessed the composition of pathogenic bacteria and the trends for antimicrobial susceptibility over a 6-year period in China.
Blood bacterial isolates from patients at hospitals participating in the Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected from January 2014 to December 2019. Only the first isolate of a species per patient was eligible over the full study period. Antibiotic-susceptibility testing was conducted by agar-dilution or broth-dilution methods as recommended by the Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.
During the study period, 27,899 bacterial strains were collected. Gram-positive organisms accounted for 29.5% (8244) of the species identified and Gram-negative organisms accounted for 70.5% (19,655). The most-commonly isolated organisms in blood cultures were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, coagulase-negative Staphylococci, and Acinetobacter baumannii. The prevalence of multidrug-resistant organisms, such as E. coli, K. pneumoniae, A. baumannii was higher in tertiary hospitals, whereas extended-spectrum, β-lactamase-producing E. coli (ESBL-E. coli), carbapenem-resistant A. baumannii were more prevalent in economically-developing areas. The prevalence of methicillin-resistant S. aureus declined from 39.0% (73/187) in 2014 to 25.9% (230/889) in 2019 (p < 0.05). The prevalence of ESBL-E. coli dropped from 61.2% (412/673) to 51.0% (1878/3,683) over time (p < 0.05), and carbapenem-resistant E. coli remained low prevalence (< 2%; 145/9944; p = 0.397). In contrast, carbapenem-resistant K. pneumoniae increased markedly from 7.0% (16/229) in 2014 to 19.6% (325/1,655) in 2019 (p < 0.05).
E. coli and K. pneumoniae were the leading causes of BSI during the 6-year study period. The major resistant pathogens declined or remained stable, whereas carbapenem-resistant K. pneumoniae continued to increase, which poses a great therapeutic challenge for BSIs.
在这项中国首次全国血流感染（BSI）监测项目中，我们评估了 6 年来中国病原菌构成比和抗菌药物敏感性趋势。
本研究纳入了 2014 年 1 月至 2019 年 12 月期间参加血流细菌耐药监测协作网（BRICS）的医院患者的血培养分离菌。每位患者在整个研究期间只纳入 1 株优势菌。药敏试验采用琼脂稀释法或肉汤稀释法，按照美国临床和实验室标准协会（CLSI）的标准进行。使用 WHONET 5.6 软件进行数据分析。
研究期间共收集 27899 株细菌。革兰阳性菌占鉴定菌的 29.5%（8244 株），革兰阴性菌占 70.5%（19655 株）。血培养中最常见的分离菌为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌和鲍曼不动杆菌。在三级医院中，耐多药菌（如大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌）的流行率较高，而在经济发达地区，产超广谱β-内酰胺酶大肠埃希菌（ESBL-E. coli）和耐碳青霉烯类鲍曼不动杆菌的流行率较高。耐甲氧西林金黄色葡萄球菌的流行率从 2014 年的 39.0%（73/187）下降到 2019 年的 25.9%（230/889）（p<0.05）。ESBL-E. coli 的流行率从 61.2%（412/673）下降到 51.0%（1878/3683）（p<0.05），碳青霉烯类耐药大肠埃希菌的流行率保持较低水平（<2%；145/9944；p=0.397）。相反，碳青霉烯类耐药肺炎克雷伯菌的流行率从 2014 年的 7.0%（16/229）显著上升到 2019 年的 19.6%（325/1655）（p<0.05）。
在 6 年的研究期间，大肠埃希菌和肺炎克雷伯菌是导致 BSI 的主要原因。主要耐药病原体呈下降或稳定趋势，而碳青霉烯类耐药肺炎克雷伯菌持续增加，这对 BSI 的治疗构成了巨大挑战。
