中国临床药理学杂志

中国细菌耐药监测研究（CARST）2023-2024年革兰氏阴性菌监测报告

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李耘 ¹ , 郑波 ¹ , 崔兰卿 ¹ , 张秀珍 ² , 胡云建 ² , 金玉芬 ³ , 潘世扬 ⁴ , 郭玮 ⁵ , 赵锋 ⁶ , 俞云松 ⁷ , 蔡璇 ⁸ , 刘文恩 ⁹ , 刘德华 ¹⁰ , 费樱 ¹¹ , 刘家云 ¹² , 裴凤艳 ¹³ , 孟灵 ¹⁴ , 季萍 ¹⁵ , 汤进 ¹⁶ , 朱镭 ¹⁷ , 潘开素 ¹⁸ , 徐和平 ¹⁹ , 张健东 ²⁰ , 薛峰 ¹ , 王珊 ¹ , 刘姚姚 ¹ , 钟巍 ¹

中国临床药理学杂志 | 细菌耐药监测 2025,41(18): 2567-2587

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中国临床药理学杂志 |细菌耐药监测 2025 , 41 (18) : 2567 -2587

中国细菌耐药监测研究（CARST）2023-2024年革兰氏阴性菌监测报告

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李耘¹, 郑波¹, 崔兰卿¹, 张秀珍², 胡云建², 金玉芬³, 潘世扬⁴, 郭玮⁵, 赵锋⁶, 俞云松⁷, 蔡璇⁸, 刘文恩⁹, 刘德华¹⁰, 费樱¹¹, 刘家云¹², 裴凤艳¹³, 孟灵¹⁴, 季萍¹⁵, 汤进¹⁶, 朱镭¹⁷, 潘开素¹⁸, 徐和平¹⁹, 张健东²⁰, 薛峰¹, 王珊¹, 刘姚姚¹, 钟巍¹

作者信息

^1.北京大学第一医院临床药理研究所，北京 100034

^2.北京医院检验科，北京 100730

^3.吉林大学第二医院检验科，吉林长春 130041

^4.南京医科大学第一附属医院检验科，江苏南京 210029

^5.复旦大学中山医院检验科，上海 200023

^6.浙江大学医学院附属邵逸夫医院检验科，浙江杭州 310003

^7.浙江大学医学院附属邵逸夫医院感染科，浙江杭州 310003

^8.武汉大学人民医院检验科，湖北武汉 430060

^9.中南大学湘雅医院检验科，湖南长沙 410008

^10.昆明市第一人民医院检验科，云南昆明 650011

^11.贵州医科大学附属医院检验科，贵州贵阳 550001

^12.空军军医大学西京医院检验科，陕西西安 710032

^13.济南市中心医院检验科，山东济南 250013

^14.兰州大学第二医院检验科，甘肃兰州 730030

^15.新疆医科大学第一医院检验科，新疆维吾尔自治区乌鲁木齐 830054

^16.汉中市中心医院检验科，陕西汉中 723000

^17.山西省儿童医院检验科，山西太原 300012

^18.广西医科大学第一附属医院皮肤科，广西壮族自治区南宁 530021

^19.厦门大学附属第一医院检验科，福建厦门 361003

^20.天津市第三中心医院检验科，天津 300170

通讯作者:

郑波，教授，主任医师，博士生导师 Tel: （010）13501210391 E-mail: doctorzhengbo@163.com

作者简介:

李耘（1970-），女，副研究员，主要从事抗菌药物临床前药效研究

Antimicrobial susceptibility of gram-negative organisms: Results from China antimicrobial resistance surveillance trial (CARST) program, 2023-2024

Yun LI¹, Bo ZHENG¹, Lan-qing CUI¹, Xiu-zhen ZHANG², Yun-jian HU², Yu-fen JIN³, Shi-yang PAN⁴, Wei GUO⁵, Feng ZHAO⁶, Yun-song YU⁷, Xuan CAI⁸, Wen-en LIU⁹, De-hua LIU¹⁰, Ying FEI¹¹, Jia-yun LIU¹², Feng-yan PEI¹³, Ling MENG¹⁴, Ping JI¹⁵, Jin TANG¹⁶, Lei ZHU¹⁷, Kai-su PAN¹⁸, He-ping XU¹⁹, Jian-dong ZHANG²⁰, Feng XUE¹, Shan WANG¹, Yao-yao LIU¹, Wei ZHONG¹

Affiliations

^1.Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100034, China

^2.Clinical Laboratory, Beijing Hospital, Beijing 100730, China

^3.Clinical Laboratory, Jilin University Second Hospital, Changchun 130041, Jilin Province, China

^4.Clinical Laboratory, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China

^5.Clinical Laboratory, Zhongshan Hospital Fudan University, Shanghai 200023, China

^6.Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China

^7.Infectious Disease Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China

^8.Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China

^9.Clinical Laboratory, Xiangya Hospital Central-south University, Changsha 410008, Hunan Province, China

^10.Clinical Laboratory Kunming First People’s Hospital, Kunming 650011, Yunnan Province, China

^11.Clinical Laboratory, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China

^12.Clinical Laboratory, Air Force Military Medical University Xijing Hospital, Xi’an 710032, Shanxi Province, China

^13.Clinical Laboratory, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong Province, China

^14.Clinical Laboratory, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China

^15.Clinical Laboratory, The First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China

^16.Clinical Laboratory, Hanzhong Center Hospital, Hanzhong 723000, Shanxi Province, China

^17.Clinical Laboratory, Children’s Hospital of Shanxi, Taiyuan 300012, Shanxi Province, China

^18.Dermatology Department, The first Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China

^19.Clinical Laboratory, The first Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian Province, China

^20.Clinical Laboratory, Tianjin Third Central Hospital, Tianjin 300170, China

出版时间: 2025-09-28 doi: 10.13699/j.cnki.1001-6821.2025.18.002

文章导航

摘要

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目的

监测我国主要城市三级甲等医院感染患者分离革兰氏阴性菌耐药状况，掌握耐药流行趋势，为抗生素合理使用提供科学数据。

方法

定点收集全国18家医院临床分离细菌，由中心实验室统一用琼脂/肉汤二倍稀释法测定抗菌药物最低抑菌浓度（MIC）值。

结果

对2023年7月至2024年6月间来自全国18座城市18家医院的4 681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50.7%和20.7%，表型检出率继续下降，碳青霉烯类耐药肺炎克雷伯菌（CRKP）比例则较前次监测上升10个百分点，达35.4%。对肠杆菌目细菌抗菌作用较好的药物包括：碳青霉烯类、β-内酰胺合剂、阿米卡星等，细菌敏感率在78%以上。此外，替加环素、依拉环素和黏菌素对各自有效菌属/种保持很好抗菌活性，细菌敏感/中介（黏菌素）率>90%。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为32.7%和70.7%，多重耐药菌（MDR）检出率分别为43.3%和78.3%，泛耐药菌（XDR）检出率分别为17.0%和71.0%。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，来源重症监护病房（ICU）肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌耐药率均显著高于来源非ICU菌株。儿童分离铜绿假单胞菌对测试药物耐药率均显著低于成人与老年人，但儿童分离肺炎克雷伯菌中ESBLs表型检出率为57.1%，显著高于成人（16.3%）和老年人（19.8%），此外流感嗜血杆菌，来自儿童的菌株对头孢菌素类、阿奇霉素和四环素类耐药率均高于成人和老年人。不同标本来源比较显示，尿标本分离鲍曼不动杆菌对测试药物耐药率显著低于其他来源；其他主要菌种不同标本间在统计学上差异均无统计学意义，痰标本中的铜绿假单胞菌及来源引流液的大肠埃希菌耐药率较其他来源略高。

结论

大肠埃希菌、肺炎克雷伯菌中ESBLs表型检出率持续下降，CRKP、氨苄西林耐药流感嗜血杆菌检出率呈上升趋势，需持续关注。

关键词

细菌耐药监测 / 革兰氏阴性菌 / 最低抑菌浓度 / 敏感率 / 耐药率 / 最低抑菌浓度分布

Abstract

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Objective

To investigate the gram-negative bacteria resistance in nationwide tietiary hospitals, understand the trend of antimicrobial resistance and provide scientific data for the rational use of antibiotis.

Method

All the clinical isolates were collected from 18 hospitals and the minimal inhibitory concentrations (MICs) were tested using agar/broth dilution method recommended by Clinical and Laboratory Standards Institute (CLSI) in central laboratory.

Results

A total of 4 681 pathogenic isolates from 18 tertiary hospitals in 18 cities nationwide over the period from July 2023 to June 2024 were studied. Based on the MIC results, Escherichia coli and Klebsiella pneumoniae showed extended spectrum β-lactamase (ESBLs) phenotype rates of 50.7% and 20.7%, respectively, ESBLs phenotype rate keeps going down. The ratio of carbapenems resistance Klebsiella pneumoniae (CRKP) was 35.4%, increased by 10 percentage points compared with the previous monitoring. Carbapenems, β-lactam combination agents and amikacin displayed desirable antibacterial activity against Enterobacterales, susceptibal rates were above 78%. In addition, tigacycline, eravacycline, colistin maintained good antibacterial activity against their respective effective bacteria/species, and the bacterial sensitivity rates by more than 90%. Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannnii to imipennnem were 32.7% and 70.7% and multidrug-resistant (MDR) detection rates were 43.3% and 78.3%, Extensively drug-resistant (MDR) were 17.0% and 71.0%, respectively. Comparison of drug resistance rates from different wards, ages and specimen sources indicated that the proportion of resistance in Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii isolated from intensive care unit (ICU) were significantly higher than non-ICU. Resistance rates of Pseudomonas aeruginosa isolated from children were significantly lower than that in adults and the elderly. However, the detection rate of ESBLs phenotypes in Klebsiella pneumoniae in children was 57.1%, significantly higher than that in adults (16.3%) and the elderly (19.8%). In addition, the strains of Haemophilus influenzae from children had a higher resistance rates to cephalosporins, macrolides, and clindamycin than those in adults and the elderly. Comparisons of different specimen sources showed that the resistance rates of Acinetobacter baumannii isolated from urine specimens were significantly lower than that from other sources. No statistical differences were observed among other major bacterial species in different specimens, while the resistance rates of Pseudomonas aeruginosa in sputum specimens and Escherichia coli in source drainage fluids were slightly higher than those from other sources.

Conclusion

The detection rates of ESBLs phenotypes in Escherichia coli and Klebsiella pneumoniae have continued to decline, while the detection rates of CRKP and ampicillin-resistant Haemophilus influenzae have shown an upward trend, which requires continuous attention.

Key words

antimicrobial resistance surveillance / gram-negative bacteria / minimum inhibitory concentration / susceptibility / resistance / minimal inhibitory concentration distribution

引用本文

李耘, 郑波, 崔兰卿, 张秀珍, 胡云建, 金玉芬, 潘世扬, 郭玮, 赵锋, 俞云松, 蔡璇, 刘文恩, 刘德华, 费樱, 刘家云, 裴凤艳, 孟灵, 季萍, 汤进, 朱镭, 潘开素, 徐和平, 张健东, 薛峰, 王珊, 刘姚姚, 钟巍. 中国细菌耐药监测研究（CARST）2023-2024年革兰氏阴性菌监测报告. 中国临床药理学杂志, 2025 , 41 (18) : 2567 -2587 . DOI: 10.13699/j.cnki.1001-6821.2025.18.002

Yun LI, Bo ZHENG, Lan-qing CUI, Xiu-zhen ZHANG, Yun-jian HU, Yu-fen JIN, Shi-yang PAN, Wei GUO, Feng ZHAO, Yun-song YU, Xuan CAI, Wen-en LIU, De-hua LIU, Ying FEI, Jia-yun LIU, Feng-yan PEI, Ling MENG, Ping JI, Jin TANG, Lei ZHU, Kai-su PAN, He-ping XU, Jian-dong ZHANG, Feng XUE, Shan WANG, Yao-yao LIU, Wei ZHONG. Antimicrobial susceptibility of gram-negative organisms: Results from China antimicrobial resistance surveillance trial (CARST) program, 2023-2024[J]. Chinese Journal of Clinical Pharmacology, 2025 , 41 (18) : 2567 -2587 . DOI: 10.13699/j.cnki.1001-6821.2025.18.002

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2025年第41卷第18期

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doi: 10.13699/j.cnki.1001-6821.2025.18.002

接收时间：2025-07-10
首发时间：2026-08-05
出版时间：2025-09-28

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收稿日期：2025-07-10

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