5935 2009 13 WHONET 5. 6 2015 1332 66. 1% 683 33. 9% 27. 9% 11. 3% 10. 9% 7. 0% 6. 0% 98. 2% 98. 1% / 90. 4% 100% 99. 4% MRSA 42. 3% 42. 2% β- ESBLs 54. 7% 53. 4% MDRP 11. 9% 15. 9% MDRA 49. 0% 64. 8% HLGR 62. 6% 66. 7% 2. 1% 4. 6% HLGR 62. 6% 66. 7% 2. 1% 4. 6% MDRA HLGR MDRP 15. 8% 4. 1% 4. 0% 2. 5% Distribution and antimicrobial resistance of pathogenic bacteria in nosocomial bloodstream infection in 2007 and 2009 ZHANG Ji-xia CHEN Hong-bin WANG Hui XU Ying-chun CHEN Min-jun ZHANG Rong LIU Wen-en XU Xiu-li CAO Bin NING Yong-zhong LIAO Kang CHU Yun-zhuo HU Zhi-dong ZENG Ji WANG Yong SU Danhong ZHOU Chun-mei LI Li-hong ZOU Ming-xiang YANG Pei-hong LIU Ying-mei CHEN Dong-mei NIAN Hua TIAN Bin XIONG Yan LI Ping ZHUO Chao XIE Hong-mei. Department of Clinical Laboratory Peking Union Medical College Hospital Chinese Academy of Medical Science Beijing 100730 China Corresponding author WANG Hui Email whuibj@ gmail. com Abstract Objective To investigate the distribution and antimicrobial resistance of pathogenic bacteria of bloodstream infection from 13 clinical hospitals in China in 2007 and 2009. Methods Non-repetitive pathogens from nosocomial bloodstream infection were collected and tested for the drug-resistance. WHONET 5. 6 software was used DOI 10. 3877 /cma. j. issn. 1674-0785. 2012. 19. 118 100730 Email whuibj@ gmail. com
5936 to analyze the data. Results A total of 2015 clinical isolates were collected. Among them there were 1332 gramnegative bacilli isolates 66. 1% 683 gram-positive bacilli isolates 33. 9%. According to the isolate rate the top five pathogenic bacteria were Escherichia coli 27. 9% Klebsiella pneumoniae 11. 3% Staphylococcus aureus 10. 9% Pseudomonas aeruginosa 7. 0% and Acinetobacter baumannii 6. 0%. The antibacterial medicines with relatively high sensitivities to the gram-negative bacilli of the bloodstream infection were Tigecycline 98. 2% excluding Pseudomonas aeruginosa Polymyxine 98. 1% non-fermentative bacteria Ceftazidine / Clavulanate 90. 4% in order. The antibacterial medicines with relatively high sensitivities to the gram-positive bacilli of the bloodstream infection were Tigecycline and Linezolid Sensitivities of both were 100% Vancomycin and Teicoplanin Sensitivities of both were 99. 4%. The data indicated that the incidence of oxacillin-resistant Staphylococcus aureus MRSA was 42. 3% and 42. 2% in 2007 and 2009 respectively. The incidence of Enterobacteriaceae producing extended-spectrum β-lactamases ESBL was 54. 7% and 53. 4% in 2007 and 2009 respectively. The incidence of Multidrug Resistant Acinetobacter baumannii MDRA was 49. 0% and 64. 8% in 2007 and 2009 respectively The incidences of High Level Gentamicin Resistance HLGR of Enterobacteriaceae faecalis and Enterobacteriaceae faecium are 62. 6% and 66. 7% in 2007 and 2009 respectively The incidences of Carbapenem insensitivity of Enterobacteriaceae faecalis and Enterobacteriaceae faecium are 2. 1% and 4. 6% in 2007 and 2009 respectively. Conclusions Gram-negative bacilli Escherichia coli and Klebsiella pneumoniae mainly are the major pathogens of nosocomial bloodstream infection to which Tigecycline and Carbapenems are most sensitive. Among gram-positive bacilli Staphylococcus aureus has the highest isolation rate followed by Enterococcus faecium to which Tigecycline Linezolid Vancomycin and Teicoplanin have higher sensitivities. The drug-resistance rates of MDRA HLGR MDRP and Carbapenem insensitive Enterobacteriaceae have risen by 15. 8% 4. 1% 4. 0% and 2. 5% respectively which should be paid attention to in the clinical treatments. Key words Blood stream infections Bacterial distribution Bacterial resistance Resistance surveillance Antibacterial agents 163 162 161 1 161 160 159 159 159 140 133 121 13 Vitek2 Compact Chinese Antimicrobial ATCC25922 Resistance Surveillance of Nosocomial infection CARES 2015 ATCC29213 ATCC29212 2. 1. 13 / 2015 2 1 1332 66. 1% 683 ATCC27853 Sigma / 4 μg /ml 33. 9% 963 1052 172 165
5937 27. 9% 11. 3% Sigma 7. 0% 6. 0% / 19 1 10. 9% 5. 4% Lilly 2 Mueller-Hinton Oxoid 3. MIC CLSI MICs 98. 2% CLSI2011 M100-S21 / 98. 1% / / / 90. 4% FDA 100% 99. 4% 4. MDR 1 2011 1 17 multidrug-resistant organism MDRO / MDR > 80% β ES- > BLs MRS 95% HLGR CLSI ESBLs 100% 4 μg /ml MIC 8 8 100% ESBLsMRS 2007 95. 9% 88. 7% MIC > 6 μg /ml MRSHLGR 500 μg /ml BHI 1. 2 10 μl 0. 5 35 ESBLs ESBLs 24 h > 1 HLGR ESBLs CLSI 2011 M100-S21 MIC 2 μg /ml MIC MIC 0. 5 μg /ml MIC 2 μg /ml 8 2009 MIC 2 μg /ml ESBLs 54. 7% 53. 4% 5. WHONET 5. 6 ESBLs 1 7 10 1 40% 2009 ESBLs 3 4 7 3 2009
5938 1 % n = 483 n = 501 n = 220 n = 242 n = 59 n = 82 n = 49 n = 71 n = 91 n = 82 a 99. 0 98. 8 100 100 NA NA 95. 9 b 88. 7 b 100 100 97. 1 98. 8 40. 0 33. 9 37. 3 22. 0 46. 9 32. 4 - - 98. 3 99. 4 NA NA 66. 1 57. 3 51. 0 35. 2 NA NA /93. 2 94. 0 40. 0 34. 3 88. 1 80. 5 34. 7 33. 8 - - / 81. 4 78. 2 NA NA 83. 1 62. 2 46. 9 35. 2 NA NA 76. 0 74. 9 39. 5 34. 3 79. 7 69. 5 30. 6 32. 4 NA NA 74. 3 70. 9 NA NA 76. 3 61. 0 24. 5 31. 0 NA NA 45. 2 46. 3 NA NA NA NA NA NA NA NA 56. 6 64. 3 NA NA NA NA NA NA NA NA 48. 2 54. 1 47. 7 40. 1 72. 9 62. 2 40. 8 32. 4 25. 3 28. 0 90. 9 91. 8 NA NA 89. 8 85. 4 42. 9 38. 0 NA NA NA NA NA NA 96. 6 100 98. 0 97. 2 NA NA / NA NA 72. 7 68. 6 NA NA NA NA NA NA NA NA 100 100 NA NA NA NA 95. 6 100 NA NA 100 99. 6 NA NA NA NA 95. 6 100 NA NA 100 100 NA NA NA NA 100 100 NA NA 21. 8 19. 0 NA NA NA NA 7. 7 4. 9 - CLSI NA a CLSI FDA b FDA 2 % n = 175 n = 174 n = 95 n = 97 n = 8 n = 14 n = 40 n = 39 n = 58 n = 68 n = 17 100 100 100 100 100 100 100 94. 9 100 100 64. 7 85. 7 100 100 100 100 100 100 100 94. 9 100 100 70. 6 100 100 100 98. 9 100 100 100 100 97. 4 100 95. 6 94. 1 100 / 99. 4 96. 0 97. 9 99. 0 62. 5 92. 9 87. 5 87. 2 91. 4 98. 5 47. 1 57. 1 /67. 4 62. 6 98. 9 100 87. 5 71. 4 67. 5 43. 6 94. 8 100 64. 7 42. 9 66. 9 55. 7 100 100 25. 0 0 37. 5 41. 0 100 100 11. 8 0 1. 1 0 100 100 12. 5 0 2. 5 0 100 100 11. 8 0 1. 1 0 100 100 12. 5 14. 3 5. 0 0 98. 3 97. 1 11. 8 0 50. 3 67. 2 75. 8 93. 8 12. 5 14. 3 52. 5 74. 4 87. 9 86. 8 0 14. 3 55. 4 50. 0 100 100 87. 5 78. 6 50. 0 46. 2 100 100 64. 7 71. 4 18. 3 12. 1 50. 5 38. 1 25. 0 14. 3 42. 5 23. 1 86. 2 82. 4 17. 6 0 18. 3 24. 1 53. 7 53. 6 25. 0 14. 3 40. 0 56. 4 86. 2 94. 1 17. 6 28. 6 17. 1 22. 4 47. 4 52. 6 25. 0 14. 3 35. 0 53. 8 86. 2 91. 2 17. 6 0 93. 7 91. 4 97. 9 96. 9 50. 0 71. 4 70. 0 84. 6 98. 3 98. 5 35. 3 57. 1 39. 4 62. 1 52. 6 78. 4 25. 0 50. 0 25. 0 30. 8 58. 6 85. 3 35. 3 57. 1 n = 7
5939 3 % 6 60. 0 7 30. 4 13 39. 4 2 20. 0 4 17. 4 6 18. 2 1 10. 0 1 4. 4 2 6. 1 1 10. 0 0 0 1 3. 0 0 0 11 47. 8 11 33. 3 2007 0 2009 47. 8% 2. MDRA MDRP 4 MDRP MDRA MDR AMK CAZ CIP IMP CAZ CIP IMP AMK CIP IMP AMK CAZ IMP AMK CAZ CIP AMK CAZ CIP IMP MDR MDR % MDRP 4 1 2 0 0 7 59 11. 9 MDRA 11 1 0 1 11 24 49 49. 0 MDRP 5 5 0 0 3 13 82 15. 9 MDRA 36 3 1 0 6 46 71 64. 8 MDRP MDRA AMK CAZ CIP IMP 5 MRS MSS % MRSA MSSA MRSCoN MSSCoN n = 47 n = 46 n = 64 n = 63 n = 84 n = 113 n = 24 n = 20 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 99. 1 100 100 44. 7 52. 2 100 100 98. 8 96. 5 95. 8 100 4. 3 0 70. 3 79. 4 26. 2 19. 5 95. 8 75. 0 4. 3 2. 2 82. 8 88. 9 32. 1 20. 4 91. 7 85. 0 4. 3 8. 7 81. 2 88. 9 39. 3 24. 8 95. 8 90. 0 / 70. 2 67. 4 87. 5 90. 5 56. 0 53. 1 95. 8 85. 0 4. 3 15. 2 35. 9 36. 5 16. 7 8. 0 37. 5 40. 0 83. 0 73. 9 90. 6 87. 3 63. 1 72. 6 91. 7 80. 0 53. 2 30. 4 95. 3 98. 4 86. 9 82. 3 100 100 0 0 100 100 0 0 100 100 / 0 0 100 100 0 0 100 100 0 0 98. 4 93. 7 0 0 100 85. 0 0 0 98. 4 100 0 0 100 100 0 0 100 98. 4 0 0 100 100 MRSA MSSA MRSCoN MSSCoN
5940 2007 15. 8% 4. 0% 4 100% HL- 40% GR 4. 1% > 65% HLGR 62. 6% 66. 7% 95% 2. 1% 4. 6% 3. 4% ~ 23. 5% 3. 42. 3% 42. 2% 3 77. 8% 85. 0% 91. 7% 86. 4% 5 2009 2007 2009 13 100% 1 12. 3 9. 8 51. 9 56. 7 8. 8 3. 9 59. 3 56. 7 1. 8 2. 0 22. 2 6. 7 71. 9 56. 9 40. 7 16. 7 10% 6 % ESBLs ESBLs 54. 0% n = 57 n = 51 n = 27 n = 30 ESBLs ESBLs ESBLs 100 100 100 100 95% 100 100 100 100 94. 7 100 100 100 CTX-M- ESBLs 4 94. 7 100 100 100 ESBLs 1. 8 7. 8 96. 3 100 β- 3. 5 3. 9 40. 7 56. 7 5 CRE 6 7 KPC-2 IMP-4 IMP-8 8 4. NDM-1 9. 13% 9 5. 36% 2. 83% 6 2007 33 2009 72. 7% 24 /33 100% 56. 9%
5941 10-11 VRE VRE MDRA MDRP 2009 15. 8% 4. 0% 23S rrna 16 MDRA 64. 8% MDRA β 17 AmpC β 12-13 2007 14 2009 42. 3% 42. 2% 67. 6% 15 45. 4% 2 77. 8% 85. 0% 79. 9% 15 1 80. 2% 2 422-430. HLGR 2007. 13. 2011 34 2. Mohnarin. 2011 27 352-356.. 60% 2009 3 meta. 2010 42 304-307. 4 Wang H Kelkar S Wu W hospital in China. Antimicrob Agents Chemother 2003 et al. Clinical isolates of aeanterobacteriace peoducing extended-spectrumβ-lactamase prevalence of CTX-M-3 at a 47 790-793.
5942 5 Yigit H Queenan AM AnderSon GJ et al. Novel carbapenem-hydrolyzing beta-lactamase KPC-1 from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 200l 45 1151-1161. 6 Queenan AM Bush K. Carbapenemases the Versatile beta-lactamase. Clin Microbiol Rev 2007 20 440-458. 7 Wei ZQ Du XX Yu YS et al. Plasmid-mediated KPC-2 in a Klebsiella pneumoniae isolate from China. Antimicrob Agents Chemother 2007 51 763-765. 8 Yang QW Wang H Sun HL et al. Phenotypic and genotypic characterization of Enterobacteriaceae with decreased susceptibility to carbapenems results from large hospital-based surveillance studies in Cllina. Amtimicrob Agents Chemother 2010 54 573-577. 9 Yong D Toleman MA Giske CG et al. Characterization of a new metallo-lactamase gene blandm-1 and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Amtimicrob Agents Chemother 2009 53 5046-5054. 10 Tumbarello M Repetto E Trecarichi EM. Multidrug-resistant Pseudomonas aeruginosa bloodstream infections risk factors and mortality. Epidemiol Infect 2011 139 1740-1749. 11 Falagas ME Rafailidis PI. Attributable mortality of Acinetobacter baumannii no longer a controversial issue. Crit Care 2007 11 134. 12.. 2003 25 567-573. 13.. 2009 9 37-41. 14. CHINET. 2010 10 441-446. 15. Mohnarin 2008. 2010 35 536-542. 16.. 2011 11 22-26. 17. 1. 2010 29 955-956. 2012-08-30 19 5935-5942.. J /CD. 2012 6