2018年江苏省无锡市某地区儿童肠道携带ESBLs菌株状况调查分析

目的 调查江苏省无锡市某地区儿童肠道携带超广谱β-内酰胺酶(ESBLs)菌株状况，为临床抗感染治疗提供合理使用抗菌药物的参考依据。方法 收集2018年无锡市某实验幼儿园不同年级的健康儿童粪便样本131份和无锡市某住院儿童粪便样本107份，采用ESBLs筛查培养基初步筛选出产ESBLs的菌株，鉴定菌种类别并通过药敏试验分析耐药情况。结果 共计筛选出112株产ESBLs的细菌，均为肠杆菌科类细菌，其中健康儿童粪便样本中分离到57株，住院儿童粪便样本中分离到55株，大肠埃希菌为主要分离菌株(89.28%)。健康儿童和住院儿童肠道内携带ESBLs的菌株对头孢菌素类的头孢唑啉、头孢呋辛、头孢曲松的耐药率均在90%以上；对氨基糖苷类的妥布霉素(χ²=5.153,P=0.023)和头孢菌素类的头孢呋辛(χ²=4.003,P=0.045)的耐药性上两者差异具有统计学意义(P<0.05)。筛选得到的112株菌株中，有92株细菌存在多重耐药的情况，多重耐药率高达82.12%。此外在住院儿童中检出1株对厄他培南耐药的耐碳青霉烯类的大肠埃希菌(MIC=2)，在...

Investigation of carriage of ESBLs strains in intestinal tracts of children in a certain area of in Wuxi,Jiangsu, 2018

  Objective  To understand the carriage of extended-spectrum β-lactamase (ESBLs) strains in intestinal tracts of children in an area of Wuxi, and provide reference for the rational use of antibiotics in clinical anti-infection treatment.   Methods  A total of 131 stool samples of healthy children in child care setting and 107 stool samples of sick children in a hospital in Wuxi were collected in 2018. ESBLs screening medium was used to screen ESBLs-producing strains, strain types were identified and drug susceptibility test was conducted.   Results  A total of 112 ESBLs-producing bacterial strains were screened, including 57 strains isolated from the healthy children and 55 strains isolated from the sick children. All the strains were Enterobacteriaceae. Escherichia coli isolates accounted for the highest proportion (89.28%). The resistance rates of ESBLs strains detected in the healthy children and the sick children to cephalosporins, i.e. cefazolin, cefuroxime and ceftriaxone, were all above 90%. The differences in resistance to tobramycin (χ2=5.153, P=0.023) and cephalosporin cefuroxime (χ2=4.003, P=0.045) of aminoglycoside were significant (P<0.05). The multidrug resistance rate was as high as 82.12% (92/112). In addition, one carbapenem-resistant E. coli strain which was resistant to ertapenem was detected in the sick children (MIC=2). A multidrug resistant E. coli strain was isolated from one of the healthy child, which was not sensitive to 10 classes of antibiotics.   Conclusion  The ESBLs-producing Enterobacteriaceae usually exist in intestinal tracts of children in some areas of Wuxi, and the multidrug resistance is serious. Close attention should be paid to the rational use of antibiotics in children.