2014-2023年上海市及全国医疗机构粪肠球菌和屎肠球菌对万古霉素耐药趋势

Trend analysis of vancomycin resistance of Enterococcus faecalis and Enterococcus faecium in medical institutions of Shanghai and nationwide

    摘要
  • 摘要:
    目的 基于全国细菌耐药监测网(CARSS)2014-2023年数据，分析上海市与全国医疗机构粪肠球菌(E. faecalis)和屎肠球菌(E. faecium)对万古霉素耐药率的动态变化趋势，为优化耐药菌防控策略提供依据。
    方法 提取CARSS公布的上海市及全国E. faecalis和E. faecium万古霉素耐药率数据，采用Joinpoint回归模型(5.4.0版)计算年度变化百分比(APC)、年均变化百分比(AAPC)及其95%置信区间(CI)，分析趋势差异及统计学意义。
    结果 上海市E. faecalis耐药率呈持续显著下降(AAPC=-85.301%，P＜0.001)，2019年后维持零检出；全国耐药率降幅较缓(AAPC=-16.237%，P＜0.001)，且2019年后趋势无统计学差异(P=0.628)。对于E. faecium，上海市耐药率持续下降(AAPC=-27.838%，P＜0.001)，而全国呈现先降后升特征：2014-2020年下降(APC=-18.476%，P＜0.001)，2020-2023年快速反弹(APC=43.976%，P=0.005)，整体变化无统计学差异(AAPC=-1.459%，P=0.638)。地区比较显示，上海市两种肠球菌耐药率降幅均大于全国水平(均P＜0.001)，且未出现全国范围的耐药率反弹现象。
    结论 上海市通过抗菌药物管理和感染控制措施，在肠球菌耐药性控制方面成效显著；全国E. faecium耐药率近年反弹提示需加强基层防控。建议推广上海经验，同时关注耐药基因传播机制及新冠疫情对抗菌药物使用的影响。

     

    Abstract:
    OBJECTIVE To observe the dynamic change trends of vancomycin resistance rates of Enterococcus faecalis and Enterococcus faecium in medical institutions of Shanghai and nationwide based on the data from China Antimicrobial Resistance Surveillance System (CARSS) between 2014 and 2023 so as to provide bases for optimizing the prevention and control strategies for drug-resistant organisms.
    METHODS The data regarding to the vancomycin resistance rates of E. faecalis and E. faecium in Shanghai and nationwide were extracted from CARSS. The annual percentage change (APC), average annual percentage change (AAPC) and its 95% confidence interval (CI) were calculated by Joinpoint regression model (version 5.4.0). The differences in the changing trends and its statistical significance were analyzed.
    RESULTS The drug resistance rate of E.faecalis showed a remarkable and continuous decline in Shanghai (AAPC=-85.301%, P < 0.001), the isolation rate of the species maintained zero after 2019. The drug resistance rate nationwide showed a moderate decreasing amplitude (AAPC=-16.237%, P < 0.001), and there was no significant difference in the changing trend after 2019 (P=0.628). The drug resistance rate of E.faecium showed a continuous decline trend in Shanghai(AAPC=-27.838%, P < 0.001), while the drug resistance rate nationwide firstly declined and then rose: with the decline from 2014 to 2020 (APC=-18.476%, P < 0.001), the quick rebound from 2020 to 2023 (APC=43.976%, P=0.005), and there was no significant difference in the overall change (AAPC=-1.459%, P=0.638). The decreasing amplitudes of drug resistance rates of the two species of Enterococcus were greater in Shanghai than nationwide (all P < 0.001), and the rebounds of drug resistance rates did not emerge nationwide.
    CONCLUSIONS Shanghai has achieved remarkable effect on control of drug resistance of Enterococcus through the management of antibiotics and infection control measures. The drug resistance rate of E. faecium rebounds nationwide in recent years, indicating that the prevention and control should be strengthened in grass-roots medical institutions. It is suggested that Shanghai experience should be promoted, and the impact of transmission mechanisms of drug resistance genes and COVID-19 epidemic on the use of antibiotics should be focused on.

     

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