OBJECTIVES:To investigate the species distribution and antifungal susceptibility profiles of clinical mould isolates from China to olorofim, manogepix, amphotericin B, triazoles and echinocandins. METHODS:Isolates were collected from patients at 10 tertiary hospitals across China between 2019 and 2024. Species identification was performed by sequence analysis. Antifungal susceptibility testing was performed according to the CLSI reference methods. The cyp51A, cyp51B and hmg1 genes from triazole-resistant isolates were amplified to identify mutations associated with resistance. RESULTS:Aspergillus spp. (92.02%) remained the most prevalent pathogens, followed by Fusarium spp. (4.18%) and Mucorales (1.90%). The proportion of non-A. fumigatus isolates showed an increasing trend. The majority of Aspergillus spp. were susceptible/WT to triazoles (97.52%), with posaconazole showing the highest potency. Among the triazole-resistant Aspergillus isolates, two harboured cyp51A mutations (TR46/Y121F/T289A, G441S) and one carried an hmg1 mutation (V827L). Notably, the novel antifungals olorofim and manogepix were highly potent against most tested moulds, including triazole-resistant Aspergillus isolates. For Fusarium spp., manogepix showed low MECs, whereas olorofim and triazoles showed higher and more species-specific MICs. Both novel agents showed high MIC/MECs against Mucorales isolates, and triazole MIC distributions varied markedly between species. CONCLUSIONS:A. fumigatus sensu stricto remained the predominant pathogen while non-A. fumigatus moulds became increasingly prevalent. Triazole resistance among clinical Aspergillus isolates was uncommon but was associated with cross-resistance and target gene mutations. Novel antifungals olorofim and manogepix demonstrated potent in vitro activity against a broad range of clinical moulds, including triazole-resistant Aspergillus isolates.

[This corrects the article DOI: 10.1016/j.heliyon.2023.e14980.].

Hyperammonemia syndrome has a high mortality rate in the immunosuppressed population due to its association with mental status changes. Recently studies have shown that Ureaplasma organisms’ infection can lead to hyperammonemia in post-transplant patients. Symptoms typically occur within 30 days postoperatively. However, the late-onset hyperammonemia caused by Ureaplasma parvum infection after kidney transplantation has never been reported. In this case study, a 64-year-old Chinese male presented with symptoms such as nausea, vomiting, trouble sleeping, and deteriorating mental status 81 days after kidney transplantation. His plasma ammonia level was significantly elevated, and there was no evidence of liver synthetic dysfunction. Although common methods for ammonia clearance, such as haemodialysis and oral lactulose were initiated, his serum ammonia levels remained high. Metagenomic sequencing of serum determined Ureaplasma parvum infection. Levofloxacin and minocycline were administered respectively, which resulted in a decrease in ammonia levels, but normalization was not achieved. The computed tomographic scan revealed the presence of cerebral edema. Unfortunately, the patient eventually became brain dead with multiple organ failure. This case highlights that Ureaplasma parvum can cause late-onset hyperammonemia in kidney transplant patients. Once the mental status changes are identified, immediate empiric treatments should be initiated without waiting for a confirmed diagnosis of Ureaplasma spp. infection.

BACKGROUND:Invasive fungal infections pose a substantial threat to patients in healthcare settings globally. Recent changes in the prevalence of fungal species and challenges in conducting reference antifungal susceptibility testing emphasize the importance of monitoring fungi and their antifungal resistance. METHODS:A two-phase surveillance project was conducted in Beijing, China, involving 37 centres across 12 districts, from January 2012 to December 2013 and from January 2016 to December 2017. FINDINGS:We found that the proportion of Candida albicans in intensive care units (ICUs) during 2016-2017 exhibited a significant decline compared with the 2012-2013 period, although it remained the most predominant pathogen. In contrast, the prevalence of Nakaseomyces glabratus (formerly Candida glabrata) and Candida tropicalis notably increased during the two-phase surveillance. The high prevalence of C. tropicalis and its resistance to azole drugs posed a serious threat to patients in ICUs. The pathogens causing invasive fungal infections in Beijing were relatively sensitive to echinocandins. While C. albicans continued to exhibit susceptibility to azoles, the resistance and growth rates of C. tropicalis towards azoles were particularly prominent. Concerns were raised due to the emergence of multiple, short-term isolates of Clavispora lusitaniae and Candida parapsilosis complex in neonatal ICUs, given their similarity in antifungal susceptibilities. Such occurrences point towards the potential for transmission and persisting presence of these pathogens within the ICU environment. CONCLUSIONS:Our study complements existing data on the epidemiology of invasive fungal infections. It is imperative to exercise cautious medication management for ICU patients in Beijing, paying particular attention to azole resistance in C. tropicalis.

Bacillus licheniformis is a facultative anaerobe, gram-positive, endogenous, spore-forming bacillus. It is included in a probiotic preparation commonly used in clinical practice and is usually safe for oral administration. In this paper, we report two cases of bloodstream infection resulting from using B. licheniformis probiotic preparations for gastrointestinal bleeding. The results suggest that B. licheniformis should be used with caution in people who are immunocompromised and suffering from severe= damage to the intestinal mucosal barrier.

目的 对医院二次供水系统快速生长分枝杆菌(rapidly growing mycobacteria,RGM)检出情况进行分析,探讨改进策略及实施效果.方法 于2021年3月—4月对医院二次供水系统进行目标性监测,监测内容包括不同采样点的物表和水龙头放水30秒及10分钟后的水样RGM检出率.根据监测结果于2021年9月—11月采取改进措施.改进前、后各采集168份水样,其中放水30秒和10分钟各52份,手术室管路水64份.比较改进措施实施前后的水样和物表RGM检出率.结果 改进前、后水龙头放水30秒水样的RGM检出率分别为44.2％和7.7％,改进前、后水龙头放水10分钟水样的RGM检出率分别为25.0％和0％,差异具有统计学意义(P<0.05);改进前后各采集96个物表进行培养,RGM的检出率由改进前的8.3％下降到0％,差异具有统计学意义(P<0.05),且改进前RGM阳性检出点均位于水龙头.结论 水龙头是医院二次供水系统的重要感染源,加强水龙头周围清洁消毒等改进措施,可以使医院二次供水系统的RGM检出率得到有效控制,从而降低医院感染发生率.

目的 了解2015-2021年国内主要地区医疗机构临床分离链球菌属细菌对抗菌药物的耐药性.方法 对国内主要地区51所医院临床分离的链球菌属采用纸片扩散法(K-B法)或E试验方法或自动化商业药敏测试系统,按CHINET统一监测方案进行抗菌药物敏感性试验,并按2022年CLSI折点标准统计分析总结.结果 2015-2021年共收集到89 684株链球菌属细菌,包括肺炎链球菌35 254株(39.3％),β溶血链球菌42 563株(47.6％),草绿色链球菌11 767株(13.1％).42 563株β溶血链球菌中A群、B群以及未能鉴定分型的链球菌分别为39.8％、52.8％、7.4％.非脑脊液样本儿童患者分离的25 552株肺炎链球菌中青霉类敏感、中介、耐药(PSSP、PISP、PRSP)菌株的检出率分别为86.2％～97.7％、1.7％～6.5％和0.6％～7.3％,在成人患者7 997株中的检出率分别为92.0％～95.1％、3.8％～5.3％和1.4％～2.7％.脑脊液分离肺炎链球菌PRSP占比81.2％.无论是脑脊液或非脑脊液分离儿童和成人的肺炎链球菌对红霉素和克林霉素高度耐药,耐药率均在90％以上.β溶血链球菌对青霉素和头孢曲松均敏感,未发现耐药菌株;草绿色链球菌对青霉素的耐药率为5.7％～8.5％.46.3％～55.0％的B群β溶血链球菌对左氧氟沙星耐药,其他链球菌对左氧氟沙星仍十分敏感.链球菌属细菌中未发现利奈唑胺和万古霉素的耐药株.结论 青霉素仍是链球菌属非中枢神经系统感染的首选药物.链球菌属持续对红霉素、克林霉素高浓度耐药.

目的 了解2015-2021年我国不同地区51家医院分离的不动杆菌属分布情况和耐药变迁趋势.方法 按CHINET耐药监测方案,采用纸片扩散法或自动化仪器法对收集的菌株进行药敏试验,按CLSI 2021 年版标准判读药敏结果,采用WHONET 5.6 软件进行数据分析.结果 在此期间共分离到不动杆菌属 143 393 株,其中鲍曼不动杆菌是最常见的菌种,占所有不动杆菌属的 89.6%.呼吸道样本分离最常见的是不动杆菌属,占所有样本分离株的 73.0%.94.0%的菌株分离自住院患者,其中ICU分离的菌株占 35.5%.除米诺环素、替加环素和多黏菌素B外,不动杆菌属对其他抗菌药物如β内酰胺类、氨基糖苷类和氟喹诺酮类等耐药率较高.不同等级医院和不同科室分离的不动杆菌属对抗菌药物的耐药率存在差异.2015-2021 年鲍曼不动杆菌对头孢哌酮-舒巴坦和哌拉西林-他唑巴坦耐药率呈现上升趋势,而对替加环素和米诺环素的耐药率呈现下降趋势.碳青霉烯类耐药的鲍曼不动杆菌分离率较高,在三级医院达75.2%.结论 不动杆菌属是医院感染的重要病原菌,对临床常用抗菌药物呈现较高的耐药性.对于多重耐药不动杆菌属感染,可以采用多黏菌素B、替加环素和米诺环素等抗菌药物治疗.

Pregnant women are at a high risk of contracting listeriosis; however, there have been only a few clinical reports of maternal bacteremia occurring before 20 weeks of gestation in China. In this case report, a 28-year-old pregnant woman at 16 weeks and 4 days of gestation was admitted to our hospital suffering from fever for four days. The patient was initially diagnosed with an upper respiratory tract infection at the local community hospital; nevertheless, the cause of the infection was unknown. In our hospital, she was diagnosed with Listeria monocytogenes (L. monocytogenes) infection by the blood culture system. Before the results of blood culture were obtained, ceftriaxone and cefazolin were given for three days respectively based on clinical experience. However, the fever didn't reduce until she was treated with ampicillin. This pathogen was further identified as L. monocytogenes ST87 by serotyping, multilocus sequence typing (MLST), and virulence gene amplification. Finally, a healthy baby boy was born in our hospital, and the neonate was developing well at the 6-week postnatal follow-up visit. This case report suggests that patients with L. monocytogenes ST87-caused maternal listeriosis can have a good prognosis; however, more clinical information and molecular experiments are needed to confirm our hypothesis.

目的 监测我国主要城市三级甲等医院住院患者分离的革兰氏阴性菌的细菌耐药状况,掌握耐药流行趋势,为抗生素合理使用提供科学数据.方法 定点收集来自全国19家医院临床分离细菌,由中心实验室统一用平皿/肉汤二倍稀释法测定抗菌药物最低抑菌浓度(MIC)值.结果 对2019年7月至2020年6月来自全国19座城市19家医院的4795株临床分离致病菌进行了MIC测定.结果 显示,大肠埃希菌和肺炎克雷伯菌中超广谱β内酰胺酶(ESBLs)表型检出率分别为52.8％和23.6％,均持续下降,碳青霉烯类耐药肺炎克雷伯菌比例与前次监测持平.对肠杆菌目细菌抗菌作用较好的药物包括碳青霉烯类、阿米卡星、拉氧头孢、β内酰胺类合剂、磷霉素氨丁三醇和西他沙星等.非发酵革兰阴性菌中铜绿假单胞菌和鲍曼不动杆菌对亚安培南的耐药率分别为27.1％和70.7％,多重耐药菌(MDR)检出率分别为39.7％和74.9％,泛耐药菌(XDR)检出率分别为11.8％和69.0％.不同病房、不同年龄以及不同标本来源菌株耐药率比较提示,重症监护病房分离肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中MDR占比更高,儿童患者分离肺炎克雷伯菌中ESBLs检出率高于成人和老年人,我国儿童中细菌耐药问题不容忽视.结论 ESBLs检出率有所下降;碳青霉烯类耐药肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌比例稳定;鲍曼不动杆菌对米诺环素耐药率有所升高,值得注意.

BackgroundBloodstream infections (BSIs), especially hospital-acquired BSIs, are a major cause of morbidity and mortality. However, the details about the pathogens and antimicrobial resistance profile of BSIs across China are still lacking.MethodsAn investigation was conducted in 10 large teaching hospitals from seven geographic regions across China in 2016 based on China Antimicrobial Surveillance Network (CHINET) to profile the clinical and etiological features of BSIs.ResultsA total of 2,773 cases of BSIs were identified, a majority (97.3%) of which were monomicrobial. Overall, 38.4% (1,065/2,773) were community-acquired BSIs (CABSIs), and 61.6% (1,708/2,773) were hospital-acquired BSIs (HABSIs). Of the 2,861 pathogenic BSI isolates, 67.5% were Gram-negative bacteria, 29.6% were Gram-positive bacteria, and 2.9% were fungi. The top BSI pathogens were Escherichia coli, Klebsiella pneumoniae, coagulase-negative Staphylococci (CNS), Staphylococcus aureus, Enterococci, and Acinetobacter baumannii. Escherichia coli and K. pneumoniae isolates showed low susceptibility to penicillins, cephalosporins (except ceftazidime and cefepime), and ampicillin-sulbactam (13.1%–43.4% susceptible); moderate susceptibility (about 60% susceptible) to ceftazidime, cefepime, and aztreonam; and high susceptibility (>90%) to β-lactam/β-lactamase inhibitor combinations other than ampicillin-sulbactam, except K. pneumoniae strains to piperacillin-tazobactam (59.2% susceptible). HABSIs were associated with significantly higher prevalence of carbapenem-resistant and extended-spectrum β-lactamases-producing K. pneumoniae, methicillin-resistant S. aureus, methicillin-resistant CNS, and ampicillin-resistant Enterococci than CABSIs. Overall, 42.0% of the BSI due to S. aureus strains were resistant to methicillin.ConclusionsThe findings about BSIs in teaching hospitals across China add more scientific evidence to inform the appropriate management of the disease.

Objective To investigate the susceptibility and resistance of clinical isolates collected from hospitals in several regions of China.Methods These clinical strains were collected from 51 hospitals.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2021 breakpoints.Results A total of 301 917 clinical isolates were collected from January to December 2021,of which gram negative organisms and gram positive cocci accounted for 71.4% and 28.6% respectively.Methicillin-resistant strains in S.aureus （MRSA）,S.epidermidis and other Staphylococcus species （except S.pseudintermedius and S.schleiferi） accounted for 30.0%,80.7% and 77.7% respectively.MR strains showed much higher resistance rates to most of other antimicrobial agents than MS strains.However,92.4% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 90.7% of MRSE strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin.E.faecalis strains demonstrated much lower resistance rates to most of the drugs tested than E.faecium.A few strains of both Enterococcus species were resistant to vancomycin.The prevalence of PSSP was 97.8% in the non-meningitis S.pneumoniae isolates from children and 95.1% in the non-meningitis S.pneumoniae isolates from adults.The Enterobacterales strains were still highly susceptible to carbapenems.Overall,less than 13% of these strains were resistant to carbapenems.K.pneumoniae isolates showed increasing resistance rates to imipenem and meropenem,from 3.0% and 2.9% in 2005 to 25.0% and 26.3% in 2018.However,the resistance rates of Klebsiella pneumoniae to imipenem and meropenem decreased since 2019.About 65.6% and 66.5% of Acinetobacter spp.were resistant to imipenem and meropenem,respectively.Overall,23.0% and 18.9% of the Pseudomonas aeruginosa isolates were resistant to imipenem and meropenem,respectively.Conclusions Bacterial resistance to commonly used antibiotics is still on the rise.However,the prevalence of carbapenem-resistant K.pneumoniae and P.aeruginosa is decreasing in recent years.It is suggested that strengthening the monitoring of bacterial resistance and multidisciplinary teamwork are effective in controlling the spread of drug-resistant bacteria.

目的 比较新药头孢他啶/阿维巴坦(CZA)和其他13种常用抗菌药物对老年患者不同标本中铜绿假单胞菌(PA)的体外抗菌活性,为临床提供新的治疗思路.方法 连续收集2020年1月1日到6月30日期间北京医院老年患者90株PA,用纸片扩散法测定CZA及其他13种抗菌药物的体外抗菌活性.使用软件WHO?NET 5.6和SPSS 19.0进行数据统计和分析.结果 测定的菌株中,CZA的敏感率达到94.4％,明显优于头孢他啶(68.9％)和美罗培南(54.4％)的敏感率(P<0.01).CZA对碳青霉烯类药物非敏感PA(CnSPA)和碳青霉烯类药物敏感PA(CSPA)的敏感率分别为89.8％和100.0％(P=0.10).在不同老年年龄组中,CZA的敏感率均达到85.0％以上.结论 CZA对于老年患者PA有较好的体外活性,较测定的其他β-内酰胺类药物有敏感性优势,是治疗PA感染的潜在方案.

目的 监测国内主要地区医疗机构临床分离菌对抗菌药物的敏感性.方法 对全国52所医院临床分离菌采用纸片扩散法或自动化仪器法按CHINET统一监测方案进行抗菌药物敏感性试验.按2020年CLSI折点标准判断结果.结果 收集2020年1—12月上述医院临床分离菌共251135株,其中革兰阳性菌占28.1％,革兰阴性菌占71.9％.金黄色葡萄球菌、表皮葡萄球菌和其他凝固酶阴性葡萄球菌(除假中间葡萄球菌和施氏葡萄球菌外)中甲氧西林耐药株(MRSA、MRSE和其他MRCNS)的检出率分别为31.0％、81.7％和77.5％,甲氧西林耐药株对绝大多数抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA、MSSE和其他MSCNS).MRSA中有93.6％菌株对甲氧苄啶-磺胺甲噁唑敏感;MRSE中有89.9％的菌株对利福平敏感;未发现万古霉素耐药株.肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株.2020年儿童和成人中分离的非脑膜炎肺炎链球菌中青霉素敏感株(PSSP)(96.7％和95.5％)所占比例较2019年有所上升,青霉素中介和耐药株(PISP和PRSP)的检出率有所下降.除克雷伯菌属对亚胺培南和美罗培南的耐药率分别为21.5％和22.4％外,肠杆菌目细菌对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于12％.2005—2020年16年的监测显示,肺炎克雷伯菌对亚胺培南和美罗培南的耐药率从2005年的3.0％和2.9％持续上升至2018年的25.0％和26.3％,但从2019年和2020年开始呈连续下降趋势.此外,不动杆菌属对亚胺培南和美罗培南的耐药率分别为68.1％和69.0％,铜绿假单胞菌对上述两药的耐药率分别为23.2％和19.3％.结论 临床分离菌对常见抗菌药物的耐药率虽仍呈增长趋势,但如碳青霉烯类耐药的肺炎克雷伯菌和铜绿假单胞菌等多种重要的碳青霉烯类耐药细菌的检出率在多年升高的情况下,近年来呈现连续下降趋势,提示加强细菌耐药监测,结合医院感染预防控制措施,对控制耐药细菌的流行播散是行之有效的.

产单核李斯特菌（LM）是一种食源性条件致病菌，其感染可导致李斯特菌病（LD）。本文报道1例孕16周孕妇血培养中分离到LM的诊疗经过及妊娠结局。

目的 监测国内主要地区医疗机构临床分离菌对抗菌药物的敏感性.方法 对国内主要地区36所三级医院临床分离菌采用纸片扩散法或自动化仪器法按CHINET统一监测方案进行抗菌药物敏感性试验.按CLSI文件标准判断结果.结果 收集2019年1-12月上述医院临床分离菌共249 758株,其中革兰阳性菌占29.0％,革兰阴性菌占71.0％.金黄色葡萄球菌、表皮葡萄球菌和其他凝固酶阴性葡萄球菌(除假中间葡萄球菌和施氏葡萄球菌)中甲氧西林耐药株的检出率分别为31.4％、82.4％和78.3％.甲氧西林耐药株(MRSA、MRSE和MRCNS)对绝大多数抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA、MSSE和MSCNS).MRSA中有92.6％的菌株对甲氧苄啶-磺胺甲(口恶)唑敏感;MRSE中有89.0％的菌株对利福平敏感;未发现万古霉素耐药株.肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株.2019年儿童和成人中分离的肺炎链球菌中PSSP(95.2％和95.3％)所占比例较2018年有所上升,PISP和PRSP的检出率有所下降.除肺炎克雷伯菌对碳青霉烯类的耐药率为27.6％外,肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于10％.2005-2019年15年的监测数据显示肺炎克雷伯菌对亚胺培南和美罗培南的耐药率呈持续上升趋势(3.0％和2.9％对25.3％和26.8％).此外,不动杆菌属对亚胺培南和美罗培南的耐药率分别为73.6％和75.1％;铜绿假单胞菌对上述两药的耐药率分别为27.5％和23.5％.结论 临床分离菌对常用抗菌药物的耐药率仍呈增长趋势,尤其是碳青霉烯类耐药革兰阴性杆菌.为应对严峻的全国细菌耐药形势,需各相关部门协作以遏制细菌耐药.

OBJECTIVE:Invasive candidiasis (IC), a life-threatening fungal infection prevalent among hospitalized patients, has highly variable regional epidemiology. We conducted a multicenter surveillance study to investigate recent trends in species distribution and antifungal susceptibility patterns among IC-associated Candida spp. in Beijing, China, from 2016 to 2017.MATERIALS AND METHODS:A total of 1496 non-duplicate Candida isolates, recovered from blood and other sterile body fluids of IC patients, were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry combined with ribosomal DNA internal transcribed spacer (ITS) region sequencing. Broth microdilution-based susceptibility testing using six antifungal agents was also conducted.RESULTS:Candida albicans was the most frequently isolated species (49.9%), followed by Candida tropicalis (15.5%), Candida glabrata (14.7%) and Candida parapsilosis (14.2%). No significant differences in species distribution were observed when compared with a 2012-2013 dataset. Overall, the rates of susceptibility to fluconazole and voriconazole were high among C. albicans (98% and 97.2%, respectively) and C. parapsilosis species complex (91.1% and 92%, respectively) isolates but low among C. tropicalis (81.5% and 81.1%, respectively) isolates. In addition, the rate of azole resistance among C. tropicalis isolates increased significantly (1.8-fold, P<0.05) compared with that observed in 2012-2013, while micafungin resistance rates were <5% for all tested Candida species.CONCLUSION:Our results suggest that species distribution has remained stable among IC-associated Candida isolates in Beijing. Resistance to micafungin was rare, but increased azole resistance among C. tropicalis isolates was noted. Our study provides information on local epidemiology that will be important for the selection of empirical antifungal agents and contributes to global assessments of antifungal resistance.

目的:评价比阿培南等10种抗菌药物对临床分离革兰阴性杆菌的体外抗菌活性.方法:采用琼脂对倍稀释法测定比阿培南、厄他培南、亚胺培南、美罗培南等10种抗菌药物对临床分离革兰阴性杆菌的最低抑菌浓度,所有数据用WHONET 5.6进行分析比较.结果:比阿培南对于肠杆菌科中的大肠埃希菌、非CR-肺炎克雷伯菌、其他肠杆菌科细菌均显示出良好的抗菌活性,比阿培南的MIC50和MIC90与美罗培南相似,敏感率(97.8％,100％,88.2％)与美罗培南相似,优于亚胺培南和厄他培南.对于CR-肺炎克雷伯菌,比阿培南的敏感率(20.6％)高于其他抗菌药物,MIC50和MIC90等于或低于美罗培南.对于非发酵菌中的不动杆菌属比阿培南的敏感率(40.9％)低于头孢哌酮舒巴坦(50％)和阿米卡星(50％),优于环丙沙星(27.3％),与其他碳青霉烯类抗菌药物相似(40.9％),比阿培南的MIC50和MIC90与美罗培南及亚胺培南相似.对于铜绿假单胞菌比阿培南的敏感率(63.6％)优于亚胺培南(59.1％),与美罗培南相似,但不及其他抗菌药物(68.2％～95.5％).结论:对于临床常见分离的革兰阴性杆菌比阿培南和美罗培南活性相仿.

目的 监测国内各省市主要医疗机构临床分离菌株对抗菌药物的敏感性.方法 对国内主要地区44所医院临床分离菌按CHINET统一监测方案进行抗菌药物敏感性试验.按2018年CLSI文件标准判断结果.结果 收集2018年1-12月上述医院临床分离菌共244 843株,其中革兰阳性菌占28.2％,革兰阴性菌占71.8％.金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)的平均检出率分别为34.0％和78.9％.MRSA和MRCNS对绝大多数测试药的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS).MRSA中有92.2％的菌株对甲氧苄啶-磺胺甲(口恶)唑敏感;MRCNS中有88.0％的菌株对利福平敏感;未发现万古霉素耐药株.肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠球菌,两者中均有少数万古霉素耐药株.肺炎链球菌非脑膜炎株儿童株中PSSP(89.4％)和PRSP(1.7％)所占比例较2016年有所下降.肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,多数菌属的耐药率低于17％(除克雷伯菌属外).肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别从2005年的3.0％和2.9％上升到了2018年的25.0％和26.3％.与此同时,肺炎克雷伯菌每年的占比亦呈逐步上升趋势.不动杆菌属(鲍曼不动杆菌占92.5％)对亚胺培南和美罗培南的耐药率分别为73.2％和73.9％;铜绿假单胞菌对上述两药的耐药率分别为30.7％和25.8％;耐药率均呈上升趋势.结论 临床分离菌对常见抗菌药物的耐药率仍呈增长趋势,尤其是碳青霉烯类耐药肺炎克雷伯菌,应加强医院感染防控措施和抗菌药物临床应用管理措施,在继续做好细菌耐药监测工作的同时加强实验室与临床的沟通,以发挥细菌耐药监测工作的最大价值.

基质辅助激光解吸电离飞行时间质谱(Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,MALDI-TOF MS)技术,简称飞行质谱技术,是近年来临床微生物鉴定领域最具代表性的技术之一.每种微生物都由自身独特的肽/蛋白质组成,通过MALDI-TOF MS检测微生物的肽/蛋白质指纹图谱,经软件处理并与微生物数据库进行比对分析,可在几分钟之内完成对微生物种、属水平的鉴定[1-2].与传统的检测微生物表型和生理生化方法相比,MALDI-TOF MS具有快速、准确、高通量、和低成本的优势[3-4].除了可鉴定常见细菌和酵母样真菌[5],更极大提高了临床微生物实验室对苛养菌、厌氧菌、丝状真菌以及分枝杆菌等难鉴定微生物的鉴定效率和能力[6-12].对MALDI-TOF MS系统开发耐药性分析、细菌同源性分析及阳性血培养、无菌体液细菌直接鉴定等工作尚处在科研阶段[13-19] ,随着研究的成熟和标准化的实现,有望逐步从研究走入临床应用.