Carbapenem resistance is often treated as a stable clinical phenotype, although plasmid structural variation can generate closely related isolates with divergent susceptibility profiles. We investigated longitudinal Klebsiella pneumoniae isolates recovered from one patient during hospitalization. Resistant KP02 and KP03 and susceptible KP04 belonged to ST37/KL104; KP03 and KP04 were recovered from the same wound specimen and primary culture. Independent sequencing of three colonies from each isolate showed stable within-isolate genomic states and no mutually differing single-nucleotide polymorphisms in the shared callable core. The reassemble data sequences identified a 10,483-bp difference between the IncHI1B/IncFIB(K) multireplicon plasmids Pkp02_1 and Pkp04_1. The interval was delimited by two identical direct repeats containing sul1 and qacEΔ1, and read-level validation, an independent assembly, and structural PCR supported a repeat-associated deletion. An outward-facing PCR product was compatible with a candidate circular intermediate, although its complete circular sequence and abundance remain unresolved. Under antibiotic-free conditions, the module-lacking isolate showed higher growth and final biomass; this association was not assigned uniquely to the deleted module. This single-patient study provides a clinically grounded, hypothesis-generating model for how repeat-associated plasmid rearrangements may contribute to carbapenem phenotypic heterogeneity.

Rapid and accurate identification of pathogenic bacteria is essential for safeguarding public health. However, existing approaches, including conventional culture methods, microscopic examination, modern molecular biology techniques, and sophisticated instrumental analyses, still suffer from lengthy processing times, operational complexity, high costs, and susceptibility to interference. Such limitations impede meeting the increasing demand for rapid, sensitive, cost-effective, and user-friendly pathogenic bacterial identification across diverse application scenarios. Consequently, the development of more advanced identification methodologies remains a critical research objective. Surface-enhanced Raman spectroscopy (SERS), owing to its high sensitivity, rapid measurement capability, optical probing characteristics, and molecular fingerprint information, has become a focal point in pathogenic bacterial identification research and has been applied in clinical diagnostics, food safety, environmental monitoring, and agriculture. This review systematically highlights the latest advances in the field of SERS-based pathogenic bacterial identification, drawing on 126 articles published by the American Chemical Society, Elsevier, Wiley, and other leading publishers. It details key breakthroughs in substrate fabrication, sample enrichment strategies, and precise strain discrimination. It further highlights the development and application of artificial intelligence and machine learning in SERS over the past two years, emphasizing their potentially transformative impacts on the field. In addition, recent studies on SERS-based detection of pathogenic bacteria in complex clinical specimens, including blood, urine, and sputum, are examined, with particular attention to improvements in diagnostic sensitivity, specificity, and the feasibility of standardization. Overall, the unique advantages of SERS as a next-generation rapid and portable diagnostic platform are discussed.

ObjectivesTo investigate the antimicrobial resistance mechanisms and intra-hospital clonal dissemination of carbapenem-resistant ST477 Klebsiella michiganensis.MethodsBetween 14 December 2019 and 23 August 2020, six K. michiganensis isolates producing NDM-type carbapenemases were recovered from Jilin Provincial People’s Hospital in China. Antimicrobial susceptibility was determined using the broth microdilution method. Whole-genome sequencing (WGS) was performed for all isolates. Sequence typing (ST), resistance genes, and plasmid types were identified using the PubMLST, ResFinder, and PlasmidFinder databases, respectively. Conjugation experiments were conducted to assess plasmid transferability. Additionally, 344 publicly available K. michiganensis genomes were retrieved and used to construct a phylogenetic tree based on core-genome single nucleotide polymorphisms (SNPs).ResultsWGS revealed that all six isolates belonged to ST477 and harbored blaNDM-1, blaSFO-1, and blaVEB-3. The maximum pairwise difference among the six isolates was only 8 SNPs, indicating clonal transmission. Antimicrobial susceptibility testing showed high-level resistance to imipenem, meropenem, and ceftazidime-avibactam, while susceptibility was retained to amikacin, aztreonam-avibactam, eravacycline, tigecycline, and colistin. Conjugation assays confirmed that the blaNDM-1-carrying plasmid was self-transmissible. Clinical data showed that four of the six patients had a history of transfer to the intensive care unit (ICU). Phylogenetic analysis combined with resistance gene profiling based on publicly available genomes revealed that 50% (175/350) of K. michiganensis isolates from human hosts carried carbapenem resistance genes. Notably, Isolates from China exhibited a higher carriage rate of carbapenemase genes (76.1%, 51/67). No ST477-related genomes were identified in current public datasets.ConclusionsThis study is the first to report the clonal dissemination of ST477 K. michiganensis harboring blaNDM-1 in a Chinese hospital.

The objective of this study was to investigate the antimicrobial resistance phenotype and genetic characteristics of a clinical ST145 Klebsiella oxytoca isolate co-producing KPC-2 and IMP-96 carbapenemases. The isolate was first identified by MALDI-TOF MS. PCR and Sanger sequencing were used to detect carbapenem resistance genes. Antimicrobial susceptibility testing was performed using broth microdilution. Whole genome sequencing was carried out using Illumina and Nanopore platforms. Conjugation experiments and comparative genomic analysis were used to assess plasmid transferability and the genetic context of resistance genes. A total of 103 K. oxytoca genome sequences were retrieved from public databases and, together with the isolate from this study, used to construct a core genome single nucleotide polymorphism (SNP)-based phylogenetic tree. The antimicrobial resistance genes carried by each strain were also analyzed. Antimicrobial susceptibility testing revealed that K. oxytoca K31 was resistant to cephalosporins, carbapenems, and ceftazidime-avibactam (MIC range: 8 to >64 µg/mL), but susceptible to amikacin, meropenem-vaborbactam, aztreonam-avibactam, eravacycline, tigecycline, and colistin. Whole genome sequencing analysis showed that the strain was classified as ST 145. The blaKPC-2 and blaIMP-96 genes were located on IncFIB(K)-like and IncM1 plasmids, respectively. Conjugation experiments confirmed that both plasmids carrying carbapenem resistance genes were transferable to recipient strain Escherichia coli J53 and conferred carbapenem resistance. Comparative genomic analysis indicated that the blaKPC-2 gene was located in the variable region of a Tn3 family transposon, whereas the blaIMP-96 gene was embedded in a gene cassette captured by the IntI1. Genomic analysis of 104 ST145 K. oxytoca isolates revealed that 94.2% (98/104) harbored at least one carbapenem resistance gene. This study is the first report of a clinical isolate of ST145 K. oxytoca co-producing blaKPC-2 and blaIMP-96. Both resistance genes are located on mobile genetic elements that can be transferred between different bacterial species, facilitating the spread of antimicrobial resistance. IMPORTANCE:Carbapenem-resistant Klebsiella oxytoca has been increasingly reported worldwide; however, isolates co-producing both class A and class B carbapenemases remain rare. This study reported a clinical ST145 K. oxytoca isolate co-harboring the blaKPC-2 and blaIMP-96 resistance genes, which exhibited high-level resistance to both carbapenems and ceftazidime-avibactam. The two carbapenemase genes were located on conjugative plasmids separately with autonomous transfer capability. Genetic context analysis revealed that both resistance genes were embedded in mobile genetic elements, which likely mediate their capture and horizontal transfer across bacterial species. The widespread distribution of such mobile elements carrying resistance genes accelerates the evolution of multidrug-resistant bacteria. Genomic analysis of global ST145 K. oxytoca strains further indicated that this sequence type represents a high-risk, multidrug-resistant clonal lineage with significant public health implications. Enhanced surveillance and screening of ST145 K. oxytoca are warranted to limit its further global spread.

ABSTRACT Morganella morganii , encompassing two subspecies, subsp. morganii and subsp. sibonii , is a common opportunistic pathogen, notable for intrinsic resistance to multiple antimicrobial agents. Despite its clinical significance, research into the potential evolutionary dynamics of M. morganii remains limited. This study involved the analysis of genome sequences from 431 M . morganii isolates, comprising 206 isolates that cause host infections, obtained from this study and 225 from the NCBI genome data sets. A diverse array of antimicrobial resistance genes (ARGs) was identified in M. morganii isolates, including mcr-1 , tet (X4), tmexCD-toprJ , and various carbapenemase genes. In addition, a novel bla KPC-2 -bearing plasmid with demonstrated conjugative capability was discovered in M. morganii . The majority of virulence-related genes (VRGs), except for the hlyCABD gene cluster, were found in almost all M. morganii . Three novel genospecies of M. morganii were identified, designated as M. chanii , M. variant1 , and M. variant2 . Compared to M. sibonii , M. chanii genospecies possessed a greater number of flagellar-related genes, typically located within mobile genetic elements (MGEs), suggesting potential for better environmental adaptability. Phylogenetic analysis further disclosed that M. morganii was divided into 12 sequence clusters (SCs). Particularly, SC9 harbored an elevated abundance of ARGs and VRGs, mainly toxin-related genes, and was associated with a higher presence of MGEs compared to non-SC9 strains. The collective findings suggest that M. morganii undergoes evolution driven by the influence of MGEs, thereby significantly enhancing its adaptability to selective pressures of environmental changes and clinical antimicrobial agents. IMPORTANCE The growing clinical significance of Morganella morganii arises from its abundant virulence factors and antimicrobial resistance genes, resulting in elevated infection rates and increased clinical scrutiny. However, research on the molecular epidemiology and evolutionary trends of M. morganii has been scarce. Our study established a list of virulence-related genes (VRGs) for M. morganii and conducted a large-scale epidemiological investigation into these VRGs. Based on genomic classification, three novel genotypes of M. morganii were identified, representing evolutionary adaptations and responses to environmental challenges. Furthermore, we discovered the emergence of a sequence cluster enriched with antimicrobial resistance genes, VRGs, and mobile genetic elements, attributed to the selective pressure of antimicrobial agents. In addition, we identified a novel conjugative plasmid harboring the bla KPC-2 gene. These findings hold significance in monitoring and comprehending the epidemiology of M. morganii .

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.

Objective To study the epidemiology of mold infectionsin China. Methods Based on the surveillance data of hospitals participating in theChina Hospital Invasive Fungal Surveillance Netfrom Jan 2019 to Jun 2022， the general information of patients and the epidemiological characteristics such as the proportion of strains were analyzed by WHONET software. Results A total of 16285 mold infections were included in the analysis， with the median age of 60 years old， of which 49.3% were patients aged 61 and over. The proportion ofmales was significantly higher than females （62.1% vs 37.9%）. The patients were mainly from the internal medicine and ICU wards. Most strains were isolated fromlowerrespiratory tract， accounting for 81.7%， followed by pus and secretions （7.8%）. About the species distribution， Aspergillus spp. accounted for the highest proportion （84.8%）， with Penicillium spp.， Fusariumspp.，order Mucorales andSedosporium spp. accounting for 5.1%， 3.0%， 1.3% and 0.4%， respectively. For species distribution among different mold infection， 88.7% of lower respiratory tract mold infections were caused by Aspergillus spp.， and Aspergillus fumigatus（47.8%） was the most common species. Theotomycosis was mainly caused by Aspergillus spp. （98.7%）， of which Aspergillus terreus accounted for 39.7%. Fusarium spp.（54.6%） was the most common species among ophthalmomycosis. Conclusion By the retrospective analysis of mold isolation from multicenter in China， it was found that Aspergillus fumigatus， Aspergillus terreus， and Fusarium spp. were the most common species causing pneumonomycosis，otomycosis，and ophthalmomycosis， respectively. It is necessary to pay attention to the difference in the species distribution among different mold infections in clinical empirical treatment of fungal infections.

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.

目的 了解泌尿系统感染细菌的分布特征及耐药性。方法 收集2021年1月至12月吉林大学中日联谊医院患者尿培养阳性分离出的1536株细菌，使用WHONET5.6软件，分析细菌的分布特征及其对抗菌药物的耐药情况。结果 在所分离的1536株细菌中以革兰阴性菌为主，共1132株（73.7%）,革兰阳性菌404株（26.3%）。大肠埃希菌和肺炎克雷伯菌对含β-内酰胺酶抑制剂复方制剂和碳青霉烯类药物耐药率较低。粪肠球菌和屎肠球菌对利奈唑胺及万古霉素耐药率较低。在大肠埃希菌和肺炎克雷伯菌中，女性对抗菌药物的敏感性要大于男性。结论 革兰阴性菌是我院尿培养主要的分离细菌，在临床诊疗过程中可根据药敏结果选择合适的抗菌药物，对患者进行有效治疗的同时加强对耐药细菌的防控。

目的 了解重症监护病房(ICU)患者感染细菌的分布特征及耐药性.方法 收集2020年至2022年吉林大学中日联谊医院ICU患者分离的1 373株细菌,使用WHONET5.6软件,分析细菌的分布特征及其对抗菌药物的耐药情况.结果 在所分离的1 373株细菌中以革兰阴性菌为主,共827株(60.2％),主要包括肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌及大肠埃希菌.革兰阳性菌546株(39.8％),主要以屎肠球菌及表皮葡萄球菌为主.标本来源以呼吸道(40.9％)、血液(28.3％)和尿(11.8％)占比最高.肺炎克雷伯菌对黏菌素和替加环素最为敏感,对头孢他啶及头孢吡肟的耐药率均在25％左右.大肠埃希菌对碳青霉烯类药物、阿米卡星及替加环素的耐药率保持较低水平.鲍曼不动杆菌对多种抗菌药物的耐药率均偏高,对亚胺培南及美罗培南的耐药率超过了 85％.铜绿假单胞菌对碳青霉烯类药物及喹诺酮类药物的耐药率近3年有一定程度的上升.屎肠球菌及表皮葡萄球菌各发现1株利奈唑胺的耐药菌.结论 革兰阴性菌是吉林大学中日联谊医院ICU患者分离的主要细菌,且各类细菌在不同年份的耐药性略有不同,需在合理使用抗菌药物的同时加强对ICU分离细菌的检测及医院内感染的防控,避免耐药菌的传播以及细菌耐药性的上升.

Infections caused by multidrug-resistant (MDR) Enterobacterales , especially carbapenem-resistant Enterobacterales (CRE), have been a challenging clinical problem due to the limited therapeutic options. Therefore, the need to develop novel antimicrobial agents and evaluate their activities against Enterobacterales in vitro is urgent.

当前,细菌耐药已成为全球公共健康领域的重大挑战,其中尤以碳青霉烯类耐药肠杆菌目细菌(carbapenem-resistant Enterobacterales, CRE)引起的感染形势最为严峻.碳青霉烯类抗生素包括亚胺培南、美罗培南和厄他培南等,是治疗多重耐药革兰阴性杆菌所致感染最有效的抗菌药物之一.

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.

胃肠疾病是临床最常见的疾病,外科手术是胃肠外科患者最常用的治疗手段,随着现代医疗技术的发展,先进的术式也在外科不断的更新,但由于胃肠道的解剖和生理结构,胃肠外科术后感染仍然是临床最常见的并发症之一,而手术创口的感染更是居于各类感染之首[1],严重影响了患者的预后和康复.本研究着重分析了吉林大学第一医院 2018 年至2019 年年间胃肠外科手术后切口感染分离出的143 株病原菌分布及其药敏情况,为临床医生对预防感染和进一步干预提供科学依据.

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.

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.

腹腔感染（IAIs）外科最常见,是导致患者死亡的重要病因。随着外科领域各种新技术的不断发展和抗菌药物的广泛应用,腹腔感染病原菌的种类及耐药性也在发生着变化[1]。对腹腔感染患者标本培养中常见分离细菌的种类分布和耐药性分析,能给临床经验治疗提供科学依据。本文对我院腹腔感染患者送检的标本分离细菌的菌种分布及耐药性进行分析研究,报告如下。1材料与方法1.1菌株来源我院2017年10月至2019年9月胃肠结直肠外科及肝胆外科诊断为腹腔感染的患者

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.

目的 调查2016年全国16所医院社区成人患者呼吸道3种常见临床分离菌的耐药性.方法 收集2016年1-12月全国16所医院分离的591株社区成人患者呼吸道分离菌,其中肺炎链球菌298株,流感嗜血杆菌222株,卡他莫拉菌71株.采用琼脂稀释法和肉汤微量稀释法测定不同抗菌药物对这3种菌的最低抑菌浓度.结果 按照肺炎链球菌口服青霉素的折点判定标准,62.8％(187株)的肺炎链球菌为青霉素不敏感菌株(PNSP).肺炎链球菌对大环内酯类的耐药率超过85.9％(256株),对口服头孢菌素的耐药率为54.7％～64.1％(163株～191株),对左氧氟沙星和莫西沙星的敏感率分别为96.3％(287株)和97.3％(290株).PNSP株对头孢曲松、阿莫西林-克拉维酸、头孢克洛、头孢呋辛的耐药率显著高于青霉素敏感菌株(PSSP).流感嗜血杆菌对头孢克洛、甲氧苄啶-磺胺甲嗯唑和氨苄西林的敏感率分别为33.8％、33.8％和42.8％,对其余受试抗菌药物的敏感率均超过60％;β内酰胺酶阳性检出率为35.6％(79/222),且β内酰胺酶阳性菌株对氨苄西林、克拉霉素、氯霉素和四环素的耐药率显著高于β内酰胺酶阴性株.卡他莫拉菌对除克林霉素、阿奇霉素和克拉霉素外的抗菌药物都表现出较高的敏感性.结论 肺炎链球菌、流感嗜血杆菌和卡他莫拉菌对受试的大环内酯类和口服头孢菌素类耐药率高,但左氧氟沙星和莫西沙星对肺炎链球菌、流感嗜血杆菌和卡他莫拉菌仍具有很高的抗菌活性,细菌耐药率低.