2018—2020年多中心儿童感染主要分离菌分布及耐药性分析

摘要：目的 探讨2018至2020年国内多中心儿童患者(≤14岁)分离细菌分布及耐药性情况，为临床合理使用抗菌药物提供实验室依据及指导。方法 按照全国细菌耐药监测网监测方案要求，对全国不同地区11家三级医院，进行目标细菌收集、鉴定和药敏试验，分析2018至2020年儿童患者标本来源、分离率和构成比及抗菌药物敏感性，揭示近3年来儿童组耐药数据特点及变化趋势。结果 在儿童组患者中共检出病原菌14556株，其中革兰阳性菌6200株(42.6%)，革兰阴性菌8356株(57.4%)。主要标本来源分别为呼吸道标本4855株(33.4%)、尿液2724株(18.7%)、血液1683株(11.6%)、伤口脓液1462株(10.1%)和脑脊液246株(1.7%)。呼吸道标本中，分离率最高的分别为流感嗜血杆菌(721株，14.9%)、金黄色葡萄球菌(672株，13.8%)和肺炎链球菌(670株，13.8%)；尿液标本分离率最高的是大肠埃希菌(858株，31.5%)和屎肠球菌(556株，20.4%)；伤口脓液标本以金黄色葡萄球菌(449株，30.7%)和大肠埃希菌(431株，29.5%)最为常见；血液和脑脊液标本表皮葡萄球菌检出率最高，分别为19.7%(331株)和20.7%(51株)。耐碳青霉烯类肠杆菌目细菌(CRE)检出率为16.9%(409/2416株)，耐碳青霉烯类铜绿假单胞菌(CR-PA)为12.2%(79/649株)，耐碳青霉烯类鲍曼不动杆菌(CR-AB)分离率为47.2%(395/837株)，耐甲氧西林金黄色葡萄球菌(MRSA)检出率为26.4%(589/2235株)，耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为79.0%(1017/1288株)。结论 儿童感染病原以革兰阴性菌为主，感染部位以呼吸道为主，不同部位感染的病原菌构成不同，细菌耐药率及碳青霉烯类耐药菌分离率有其特点，临床应根据监测结果进行针对性治疗。

A multicentric study on the distribution and the antibiotic sensitivity of major isolates in children infections from 2018 to 2020

Abstract Objective To explore the distribution and drug resistance of isolated bacteria in domestic multicenterpediatric patients (≤14 years old) from 2018 to 2020, and to provide laboratory evidence and guidance forthe clinical rational use of antimicrobial drugs. Methods According to the requirements of the National AntibioticResistance Surveillance Network’s monitoring program, samples from 11 member units of the Antibiotic ResistanceSurveillance Network in different regions in China were collected, identified, and drug susceptibility tests wereconducted to analyze the source, isolation rate and susceptibility of pediatric patients from 2018 to 2020. Thecomposition ratio and the sensitivity of antibacterial drugs revealed the characteristics and trend of changes in theresistance data of the child group in the past 3 years. Results A total of 14,556 strains were detected in the childrengroup, including 6,200 (42.6%) Gram-positive strains and 8356 (57.4%) Gram-negative strains. The main sources ofspecimens were 4855 strains (33.4%) of respiratory tract specimens, 2724 strains (18.7%) of urine, 1683 strains (11.6%)of blood, 1462 strains (10.1%) of wound and pus and 246 strains (1.7%) of cerebrospinal fluid. Among respiratoryspecimens, the species with high isolation rates were Haemophilus influenzae (721 strains, 14.9%), Staphylococcusaureus (672 strains, 13.8%) and Streptococcus pneumoniae (670 strains, 13.8%); species with the high isolationrates of urine specimens were Escherichia coli (858 strains, 31.5%) and Enterococcus faecium (556 strains, 20.4%);from wound and pus samples, Staphylococcus aureus (449 strains, 30.7%) and Escherichia coli (431 strains, 29.5%)were the most common strains; the detection rate of Staphylococcus epidermidis in blood and cerebrospinal fluidsamples was 19.7% (331 strains) and 20.7% (51 strains), respectively. The detection rate of carbapenem resistantEnterobacteriaceae (CRE) was 16.9% (409/2416 strains), and that of the carbapenem resistant Pseudomonasaeruginosa (CR-PA) was 12.2% (79/649 strains). The isolation rate of carbapenem resistant Acinetobacter baumannii(CR-AB) was 47.2% (395/837 strains), the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) was26.4% (589/2235 strains), and the detection rate of methicillin-resistant coagulase-negative staphylococci (MRCNS)was 79.0% (1017/1288 strains). Conclusion Gram negative bacteria were the main pathogens of children's infection,and the infection site was respiratory tract primarily. The composition of pathogens infected in different parts isdifferent. The bacterial drug resistance rate and the isolation rate of carbapenem resistant bacteria have their owncharacteristics, which suggests that targeted treatment should be carried out according to the monitoring results.