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Antimicrobial Resistance in China 中国细菌耐药现状 Minggui Wang, M.D. 王明贵 Huashan Hospital, Fudan University 复旦大学附属华山医院抗生素研究所 Shanghai, China 1

Source of data 耐药数据来源 CARSS China Antimicrobial Resistance Surveillance System, organized by Rational Drug Use Committee, Health and Family Planning Committee of China (Formerly Ministry of Health) 卫生计生委合理应用专家委员会组织的中细菌耐药监测系统 More than 1000 hospitals involved (Tertiary hospitals 74%, Secondary hospitals 24%) 1000 余家医院参加 ( 三级医院 74%, 二级医院 24%) CHINET A national bacterial resistance surveillance project in China since 2005 一个自 2005 年开始的全国性细菌耐药监测网 16 tertiary hospitals participated: 14 university hospitals, 2 children s hospitals 16 家医院参加 :14 家大学附属医院,2 家儿童医院 Shanghai Bacterial Resistance Surveillance Project 上海市细菌耐药监测网 A surveillance in Shanghai region since 1989 自 1989 年起在上海地区开展细菌耐药监测 40 hospitals (Tertiary hospitals 28, Secondary hospitals 12) 40 家医院参加 ( 三级医院 28 家, 二级医院 12 家 ) 2

Participants in CHINET bacterial resistance surveillance 2013 in China 2013 年 CHINET 监测网的参加成员 16 tertiary hospitals CHONGQING 14 univ. hospitals 2 children s hospitals 3

Outline Antimicrobial resistance in Gram-positive cocci 革兰阳性菌的耐药性 MRSA (Methicillin-resistant Staphylococcus aureus) 甲氧西林耐药金葡菌 VRE (Vancomycin-resistant Enterococci) 万古霉素耐药肠球菌 Antimicrobial resistance in Gram-negative bacilli 革兰阴性菌的耐药性 Enterobacteriaceae (Escherichia coli and Klebsiella spp.) 肠杆菌科细菌 ( 大肠埃希菌 克雷伯菌属 ) Resistant to cephalosporins: ESBL-producing 对头孢菌素的耐药 : 产超广谱 β 内酰胺酶 Resistance to carbapenems 对碳青霉烯类耐药 Non-fermenters (Pseudomonas aeruginosa and Acinetobacter spp. ) 非发酵糖细菌 ( 铜绿假单胞菌 不动杆菌属 ) Resistant to Carbapenems 对碳青霉烯类耐药 Extensive-drug resistance (XDR) 广泛耐药 4

Resistance to methicillin in Staphylococcus aureus (MRSA) is a marker of resistance level 对甲氧西林的耐药 (MRSA) 是金葡菌耐药水平的标志 MRSA strains, highly resistance to most antimicrobials MRSA 对多数抗菌药耐药 MSSA strains, susceptible to many antimicrobials MSSA 对多数抗菌药敏感 耐药率 Resistance(%) 100 90 80 70 60 50 40 30 20 10 0 MSSA(n=4620) 与 MRSA(n=3672) 的耐药率 (%) 89.3 87.2 69.4 0 0 0 0 0 0 2 0.6 0.8 1.1 万古霉素 Vacomycin MSSA MRSA 利奈唑胺 Linezolid 替考拉宁 Teicoplanin 头孢唑啉 头孢呋辛 氨苄西林 / 舒巴坦 20.8 磷霉素 5.1 53.9 利福平 14.2 11.8 7.1 复方磺胺甲噁唑 77.6 75.9 左氧氟沙星 15.5 16.1 环丙沙星 抗菌药物 Antimicrobial 69.5 庆大霉素 27.1 55.9 52.1 克林霉素 76.1 红霉素 88.6 100 100 青霉素 CHINET 2013 0 苯唑西林

Average prevalence of MRSA 36% MRSA 的平均检出率 36% Tertiary Hosp.38.5% Secondary Hosp.32% 三级医院 38.5%, 二级医院 32% CARSS 2013

检出率Prevalence (% )80 70 69.2 Decreasing trend of MRSA in China (%) 甲氧西林耐药金葡萄的检出率 (%) (CHINET 2005~2013) MRSA 检出率呈逐年下降的趋势 MRSA 60 50 58.4 58 55.9 52.7 51.7 50.6 47.9 45.2 40 30 20 10 0 2005 2006 2007 2008 2009 2010 2011 2012 2013

Low prevalence of VRE (vancomycin-resistant Enterococci) in China 万古霉素耐药肠球菌 (VRE) 的检出率 Year CHINET 2005-2013 E. faecalis 粪肠球菌 E. faecium 屎肠球菌 n VRE % n VRE % 2005 1063 0 855 0.4 2006 1298 0 1135 1.1 2007 1218 0.5 1017 2.1 2008 1520 0.4 1339 3.2 2009 1764 0.3 1605 3.5 2010 1829 0.6 1817 3.6 2011 2062 0.1 2073 3.9 2012 3131 0.3 2609 2.5 2013 3283 0.2 3062 3.0

Vancomycin-resistance in E. faecium in different provinces in China 屎肠球菌对万古霉素的耐药率 CARSS 2013 耐药率 Resistance (%) 8 7 6 5 4 3 2 1 0 三级医院北京天津陕西河北内蒙古吉林黑龙江辽宁广东广西海南重庆贵州云南四川上海江苏山东浙江福建河南湖北湖南江西安徽新疆陕西甘肃宁夏青海

Outline Antimicrobial resistance in Gram-positive cocci 革兰阳性菌的耐药性 MRSA (Methicillin-resistant Staphylococcus aureus) 甲氧西林耐药金葡菌 VRE (Vancomycin-resistant Enterococci) 万古霉素耐药肠球菌 Antimicrobial resistance in Gram-negative bacilli 革兰阴性菌的耐药性 Enterobacteriaceae (Escherichia coli and Klebsiella spp.) 肠杆菌科细菌 ( 大肠埃希菌 克雷伯菌属 ) Resistant to cephalosporins: ESBL-producing 对头孢菌素的耐药 : 产超广谱 β 内酰胺酶 Resistance to carbapenems 对碳青霉烯类耐药 Non-fermenters (Pseudomonas aeruginosa and Acinetobacter spp. ) 非发酵糖细菌 ( 铜绿假单胞菌 不动杆菌属 ) Resistant to Carbapenems 对碳青霉烯类耐药 Extensive-drug resistance (XDR) 广泛耐药 10

Prevalence of ESBL (expanded-spectrum β-lactamase) in Enterobacteracae 产超广谱 β 内酰胺酶菌株在肠杆菌科细菌中的检出率 Year 年份 E. coli 大肠埃希菌 CHINET 2005-2013 K. pneumoniae 肺炎克雷伯菌 n % n % 2005 3758 38.9 2221 39.1 2006 6072 51.7 3272 45.2 2007 6527 55.0 3244 45.1 2008 6678 56.2 3865 43.6 2009 7992 56.5 4933 41.4 2010 5386 57.2 3036 44.6 2011 11860 50.7 6981 38.5 2012 15154 55.3 9621 33.9 2013 16794 54.0 12121 31.8

Prevalence of ESBL in E. coli 大肠 ESBL 发生率 53.3% Tertiary hosp. 54.7%; Secondary hosp. 44.5% 三级医院 :54.7%; 二级医院 :44.5% CARSS 2013

CTX-M is the predominant genotype of ESBLs in Enterobateriaceae 肠杆菌科细菌产 ESBL 菌株中 CTX-M 是最常见的基因型 1.CTX-M-: 98.1% 2.SHV: 0 3.CTX-M-+SHV: 0 1.CTX-M- : 66.5% 2.SHV: 4.3% 3.CTX-M-+SHV: 21.3% 1.CTX-M-: 96.7% 2.SHV: 0 3.CTX-M-+SHV: 0 E. coli (n=158) K. pneumoniae (n=164) P. mirabilis (n=60) Wang P, J Clin Microbiol 2011; 49: 3127 13

Carbapenem-resistance in K. pneumoniae in different provinces in China (Average 4.9%) 全国 CR-KPN 分离率 (4.9%) CARSS 2013

Carbapenem-resistance in E. coli in different provinces in China (Average 1.6%) 全国 CR-ECO 分离率 (1.6%) CARSS 2013

KPC-2 is the most common carbapenemases in carbapenem-resistant K. pneumoniae 碳青霉烯类耐药肺炎克雷伯菌中最常见的碳青霉烯酶为 KPC-2 Chen S, AAC 2011; 55: 2493 109 strains of K. pneumoniae resistant to ertapenem collected at Huashan Hospital in Shanghai 2005-2010 Presence of β-lactamases: KPC-2: 71% (77/109) KPC-2+CTX-M-14 or -15: 60%(65/109) Metallo-beta-lactamases (GIM-1 or VIM-1): 9% (10/109) OXA-type carbapenemase: 10% (11/109) 16

Outline Antimicrobial resistance in Gram-positive cocci 革兰阳性菌的耐药性 MRSA (Methicillin-resistant Staphylococcus aureus) 甲氧西林耐药金葡菌 VRE (Vancomycin-resistant Enterococci) 万古霉素耐药肠球菌 Antimicrobial resistance in Gram-negative bacilli 革兰阴性菌的耐药性 Enterobacteriaceae (Escherichia coli and Klebsiella spp.) 肠杆菌科细菌 ( 大肠埃希菌 克雷伯菌属 ) Resistant to cephalosporins: ESBL-producing 对头孢菌素的耐药 : 产超广谱 β 内酰胺酶 Resistance to carbapenems 对碳青霉烯类耐药 Non-fermenters (Pseudomonas aeruginosa and Acinetobacter spp. ) 非发酵糖细菌 ( 铜绿假单胞菌 不动杆菌属 ) Resistant to Carbapenems 对碳青霉烯类耐药 Extensive-drug resistance (XDR) 广泛耐药 17

Predominant non-fermenter species 常见的非发酵糖菌菌属 Pseudomonas spp. 假单胞菌属 Pseudomonas aeruginosa 铜绿假单胞菌 Acinetobacter spp. 不动杆菌属 Acinetobacter baumannii 鲍曼不动杆菌 Stenotrophomonas spp 窄食单胞菌属 Stenotrophomonas maltophilia 嗜麦芽窄食单胞菌 Alcaligenes spp Alcaligenes faecalis Burkholderia spp. Burkholderia cepacia Chryseobacterium spp. Chryseobacterium meningosepticum 18

Relatively stable antimicrobial resistance in P. aeruginosa in Shanghai 上海地区铜绿假单胞菌对抗菌药的耐药率相对稳定 % 35 30 25 20 15 10 5 0 Cefoperazone/sulbactam 头孢哌酮舒巴坦 Ceftazidime 头孢他啶 Imipenem 亚胺培南 Shanghai Surveillance data 19

耐药率 Resistance (%) 30 25 20 15 10 5 Antimicrobial resistance in P. aeruginosa in different regions of China 铜绿假单胞菌耐药率 CARSS 2013 二级医院三级医院华北地区东北地区华南地区西南地区华东地区华中地区西北地区 0 头孢他啶 头孢吡肟 头孢哌酮 / 哌拉西林 / 舒巴坦他唑巴坦 亚胺培南 阿米卡星 左氧氟沙星 Cefoperazonesulbactam Ceftazidime Cefepime Imipenem Amikacin Levofloxacin Piperacillinclavulanic acid

Resistance rates to most antimicrobials in Acinetobacter spp. are >50% 不动杆菌属对多数抗菌药的耐药率 >50% R(%) 80 70 60 50 40 30 20 10 0 2009 2010 2011 2012 6 27 22 24 39 65 57 60 61 61 64 56 58 58 49 49 49 50 52 CHINET 2009-2012 67 63 65 67 Antimicrobial 21

Pan-drug resistance (PDR) in P. aeruginosa and A. baumannii (colistin and tigecycline not included) 糖非发酵菌的全耐药 (PDR) 发生情况 ( 不包括多粘菌素及替加环素 ) CHINET Data 25 21 21 20 17 18 18 % 15 10 5 3.2.8 10.9 2.1 1.7 1.7 1.8 1.5 1.5 铜绿假单胞菌 P. aeruginosa 鲍曼不动杆菌 A. baumannii 0 2007 2008 2009 2010 2011 2012 2013 22

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