常见细菌抗菌药物敏感性 PPT课件.pptx

3/4/2021,#,常见细菌抗菌药物敏感性,主要内容,CHINET,监测数据,本院监测数据,病原学送检率,主要内容,CHINET,监测数据,本院监测数据,病原学送检率,CHINET,数据来源,年份,医院数,株数,2005,年,8,22774,2006,年,12,33811,2007,年,12,36001,2008,年,12,36216,2009,年,14,43670,2010,年,14,47850,2011,年,15,59287,2012,年,15,72397,2013,年,16,84572,2014,年,17,78955,2015,年,20,88778,呼吸,道,尿液,血液,伤口脓液,脑脊液,标本来源分布,2015,年,CHI,N,E,T,监,测,网临,床,分离,菌,在 门急诊和住院患者中的,分,布,住院患者,（,83.5%,）,（,74156/88778,）,门急诊患者,（,16.5%,）,（,14622/88778,）,CHINET,耐药监测革兰阴性菌菌种,分,布,细菌,株数,细菌,株数,大肠埃希菌,16794,27.21,其他嗜血杆菌,177,0.29,克雷伯菌属,12121,19.64,拉乌尔菌属,114,0.18,不动杆菌属,10120,16.40,多源菌属,75,0.12,铜绿假单胞菌,8257,13.38,志贺菌属,77,0.12,肠杆菌属,3816,6.18,产碱杆菌,52,0.08,嗜麦芽窄食单胞菌,2444,3.96,奈瑟菌属,30,0.05,变形杆菌属,1835,2.97,罗尔斯顿菌属,28,0.05,沙雷菌属,1059,1.71,丛毛单胞菌,25,0.04,流感嗜血杆菌,968,1.57,普罗威登菌属,21,0.03,沙门菌属,877,1.42,气单胞菌属,21,0.03,柠檬酸杆菌属,789,1.28,黄杆菌属,15,0.02,伯克霍尔德菌属,770,1.25,金杆菌属,15,0.02,其他假单胞菌,523,0.85,博特菌属,6,0.01,摩根菌属,298,0.48,其他,91,0.15,莫拉菌属,291,0.47,合计,61709,100.0,CHINET,耐药监测革兰阳性菌菌种分布,细菌,株数,金葡菌,8127,35.55,肠球菌属,7058,30.87,凝固酶阴性葡萄球菌,4354,19.04,（血液脑脊液等无菌体液）,肺炎链球菌,1429,6.25,-,溶血性链球菌,1289,5.64,草绿色链球菌（血液及无菌体液）,515,2.25,其他,91,0.40,合计,22863,100.0,CHINET,占前六位菌株,大肠埃希菌,克雷伯,菌属,不动杆菌属,铜绿假单胞菌,金黄色葡萄球菌,肠球菌属,革兰阴性菌和阳,性,菌比例,年份,总株数,革兰阴性菌,革兰阳性菌,2005,年,22774,15244,7530,2006,年,33811,23062,10749,2007,年,36001,23637,12364,2008,年,36216,25184,11032,2009,年,43670,31002,12668,2010,年,47850,34282,13568,2011,年,59287,42415,16872,2012,年,72397,52043,20354,2013,年,84572,61709,22863,2014,年,78955,57320,21635,2015,年,88778,62297,26481,70,.,2,7,3,72,.,6,71,.,9,71,.,5,71,.,6,71,69,.,5,65,.,7,68,.,2,66,.,9,29,.,8,27,.,4,27,28,.,1,29,28.4,28.5,30,.,5,34,.,3,31,.,8,33,.,1,30,40,50,60,70,80,20,10,0,2005 2006 2007 2008 2009 2010 2011 2012 2013 2014,2015,历年革兰阴性菌和阳性菌比例变化,红色：革兰阴性菌,；,蓝色：革兰阳性菌,革兰阴性杆菌的分离率变迁,5,10,15,20,25,35,30,0,200,5,200,6,200,7,200,8,200,9,201,0,201,1,201,2,201,3,201,4,2015,大肠,埃希,菌,（,3949,）,肺炎,克雷,伯,菌,（,2136,）,鲍曼,不动,杆,菌,（,2016,）,铜绿,假单,胞,菌,（,2646,）,阴沟,肠杆,菌,（,641,）,嗜麦,芽窄,食,单胞,菌,（,1088,）,主要肠杆菌,科,细菌对亚胺培南,耐,药变化,4,2,0,8,6,16,14,12,10,18,2005,2006,2007,2008,2009,2010,2011,2012,2013,2014,2015,年份,%,大肠埃希菌,阴沟肠杆菌,弗劳地柠檬酸杆菌,肺炎克雷伯菌,CRE,肺炎克雷,伯,菌抗,菌,药的敏,感,率,2,.,1,2,.,5,2,.,9,4,.,9,9,.,8,14,.,4,33,.,8,44,.,7,49,59,.,2,0,10,20,30,40,50,60,100,90,80,70,头孢他,啶,舒普深,复方磺,胺,四环素,特治,星,头孢吡,肟,米诺环,素,环丙沙,星,替加环,素,阿米卡星,抗菌药物,敏感率（）,耐碳青霉烯类鲍曼不动杆菌抗菌药,的,敏感率,0,.,1,0,.,4,1,.,8,2,.,3,11,.,7,11,.,6,23,.,9,24,.,4,41,98,.,5,0,10,20,30,40,90,80,70,60,50,100,头孢吡,肟,特治,星,头孢他啶,环丙沙星,阿米卡星,替加环素,多黏菌,素,B,米诺环,素,舒普,深,复方磺胺,抗菌药物,敏感率（）,CRE,菌株的抗菌素敏感性,Fupin Hu,et al.,JMM,2012,61:132-136,铜绿假单胞菌的耐药率变化,23,.,4,22,.,8,16,.,5,9,.,2,30,.,5,35,.,8,27,.,6,29,.,1,27,.,1,29,.,1,29,.,1,30,.,8,30,.,5,35,.,1,32,.,5,24,.,5,25,.,2,28,.,5,26,.,4,31,.,6,25,.,8,25,27,.,1,25,.,1,26,.,1,15,.,5,16,.,6,19,.,8,19,.,8,17,.,9,18,.,2,14,.,8,25,.,7,9,.,4,11,13,.,5,14,.,3,15,.,3,14,.,8,18,.,7,16,.,5,23,10,15,20,25,30,35,40,5,0,200,5,200,6,200,7,200,8,200,9,201,0,201,1,201,2,201,3,201,4,2015,耐药率（）,亚胺培南,美罗培南,头孢哌,酮,-,舒巴坦,阿米卡星,鲍曼不动杆菌耐药率变化,45,.,8,31,30,.,1,50,60,.,4,56,.,8,62,.,8,62,.,4,62,35,.,3,48,.,1,70,.,5,66,.,7,59,.,4,61,.,4,61,.,4,58,.,3,39,40,.,9,39,.,9,52,.,4,47,.,4,46,40,.,2,48,.,7,51,.,7,57,.,1,51,.,8,58,.,4,61,38,.,1,37,.,7,36,.,4,33,39,.,1,30,.,7,23,.,6,14,.,6,5,.,3,11,.,6,25,0,10,20,30,40,50,60,70,80,2005,2006,2007,2008,2009,201,0,2011,2012,2013,2014,2015,耐药率（）,亚胺培南,美罗培南,阿米卡星,头孢哌酮,/,舒巴坦,MRSA,和,MRCNS,的检出,率,(CHINET,2005-2015),69,58,.,4,52,.,7,51,.,7,50,.,6,47,.,9,45,.,2,44,.,6,42.2,58,55,.,9,82,.,6,83,73,.,5,77,.,1,30,20,40,50,60,70,80,90,10,0,200,5,200,6,200,7,200,8,200,9,201,0,201,1,201,2,201,3,201,4,2015,耐药率（）,M,R,S,A,M,RCN,S,0.3,5,2.0,6,3.2,1,3.4,9,3.5,2,2.,6,2.1,2,3.,5,2.,4,0.,2,0,0,0.4,9,0.1,9,0.0,3,0.2,6,0.,1,0.5,5,0.2,8,0.3,9,2.4,9,0,2,1.0,6,1,3,4,5,2005200620072008200920102011201220132014,2015,年份,（,Year,）,%,粪肠球菌,屎肠球菌,VR,E,的变化,主要内容,CHINET,监测数据,本院监测数据,病原学送检率,住院患者中分离出的前六位细菌,2011,年,2012,年,2013,年,2014,年,2015,年,第一位,大肠埃,希,菌,大肠埃,希,菌,大肠埃,希,菌,大肠埃,希,菌,大肠埃,希,菌,第二位,肺炎克,雷,伯菌,肺炎克,雷,伯菌,肺炎克,雷,伯菌,肺炎克,雷,伯菌,肺炎克,雷,伯菌,第三位,鲍曼不,动,杆菌,鲍曼不,动,杆菌,鲍曼不,动,杆菌,金黄色,葡,萄球菌,表皮葡,萄,球菌,第四位,其他葡,萄,球菌,真菌,金葡菌,鲍曼不,动,杆菌,金葡菌,第五位,白色念,珠,菌,其他葡,萄,球菌,表皮葡,萄,球菌,表皮葡,萄,球菌,鲍曼不,动,杆菌,第六位,表皮葡,萄,球菌,肠球菌属,屎肠球菌,屎肠球菌,铜绿假,单,胞菌,2013,年,CHINET前,六,位,依,次,为,：大,肠,埃希,菌,，,克,雷,伯,菌,属,，,不动杆,菌,属,，,铜,绿假单,胞,菌，,金,黄色葡,萄,球菌,，,肠球菌属,注：数,字,为,2015,年,耐药率,，,由于,药敏,试纸选,择,的差,异，,历年缺,少,部分,数,据,8,6,.8,57.3,5.7,.,79,71.9,4,35,.6,10.9,27.5,8.6,3.9,1,.4,40.8,12.7,34,.7,32.7,45.1,54,.4,3.2,0,50,1,0,0,1,5,0,2,0,0,2,5,0,3,0,0,3,5,0,4,0,0,5,0,0,4,5,0,2011-2015年本,院,大,肠埃希菌耐,药,性,变化,（%）,2,0,1,1,年,2,0,1,2,年,2,0,1,3,年,2,0,1,4,年,2,0,1,5,年,74.2,17.8,82,.8,73.9,59,39.2,40.4,21.4,12,4.2,25.1,7,60.8,11.7,7,36.3,32.9,0,1,0,0,2,0,0,3,0,0,4,0,0,500,96.1,6,0,0,2011-2015年本,院,肺炎克雷伯杆,菌,耐药性变化（%）,2,0,1,1,年,2,0,1,2,年,2,0,1,3,年,2,0,1,4,年,2,0,1,5,年,注：数,字,为,2015,年,耐药率,，,由于,药敏,试纸选,择,的差,异，,历年缺,少,部分,数,据,52.7,51.7,60.1,98.2,41.5,56.4,53.4,51.8,46.6,95.4,51.2,39.6,33,99.1,0,1,0,0,2,0,0,3,0,0,500,98.8,400,6,0,0,2011-2015年本,院,鲍曼不动杆菌,耐,药性变化（%）,2,0,1,1,年,2,0,1,2,年,2,0,1,3,年,2,0,1,4,年,2,0,1,5,年,注：数,字,为,2015,年,耐药率,，,由于,药敏,试纸选,择,的差,异，,历年缺,少,部分,数,据,0,10,3.4,.4,99,19.6,8.4,5.6,0,10,1,5.1,2.2,4.5,3.9,2.8,1.1,0,10,0,10,0,1,0,0,2,0,0,3。