2018年河南省儿童医院细菌耐药性监测

目的了解2018年河南省儿童医院临床分离菌的分布及细菌耐药情况。方法收集2018年1-12月临床分离的非重复菌株,采用质谱仪进行鉴定,自动化仪器法和纸片法进行抗菌药物敏感性试验,按2018年CLSI推荐的药敏试验方法及折点标准进行药敏试验和判读药敏结果。结果共分离临床非重复菌株8825株,其中革兰阳性菌占32.5%(2867/8825),革兰阴性菌占67.5%(5958/8825)。分离最多的前5位细菌为:嗜血杆菌属、肺炎链球菌、大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌。检出6株青霉素不敏感肺炎链球菌,2株非脑膜炎株和4株脑膜炎株。葡萄球菌中MRSA和MRCNS分别占各自菌种的36.6%和77.5%,未发现对万古霉素和利奈唑胺不敏感菌株。屎肠球菌对大部分抗菌药物的耐药率高于粪肠球菌,未发现对利奈唑胺和万古霉素不敏感的肠球菌。流感嗜血杆菌和副流感嗜血杆菌的β内酰胺酶阳性率分别为58.0%和60.3%。大肠埃希菌和肺炎克雷伯菌中产ESBL的检出率分别为66.6%和72.0%,产ESBL菌株对多数抗菌药物的耐药率高于非产ESBL菌株。肺炎克雷伯菌对美罗培南和亚胺培南的耐药率为43.1%和43.2%;大肠埃希菌对美罗培南和亚胺培南的耐药率为4.5%和4.2%。铜绿假单胞菌对美罗培南和亚胺培南耐药率为21.2%和19.6%;鲍曼不动杆菌对美罗培南和亚胺培南的耐药率均为54.0%。结论多重耐药菌株在儿童中的感染形势严峻,威胁着儿科临床的抗感染治疗,应加强细菌耐药监测和合理使用抗菌药物。

Antimicrobial resistance surveillance in clinical isolates from Henan Children’s Hospital in 2018

Objective To investigate the distribution and resistance profile of clinical isolates from Henan Children’s Hospital in 2018.Methods All clinical strains isolated from Henan Children’s Hospital in 2018 were identified by mass spectrometer.Kirby-Bauer method and automated microbiology systems were used to study the antimicrobial susceptibility.The data were analyzed according to CLSI 2018 breakpoints.Results A total of 8825 strains were collected,including gram-positive bacteria(32.5%,2867/8825)and gram-negative isolates(67.5%,5958/8825).The top 5 bacterial species were Haemophilus spp.,S.pneumoniae,E.coli,K.pneumoniae,and S.aureus.Two non-cerebrospinal fluid(CSF)-derived S.pneumoniae isolates and 4 strains of S.pneumoniae isolated from CSF were not susceptible to penicillin.The prevalence of methicillin-resistant strains was 36.6% in S.aureus(MRSA)and 77.5%in coagulase-negative Staphylococcus(MRCNS).No staphylococcal strains were found resistant to vancomycin or linezolid.E.faecium strains showed higher resistance rates to most antimicrobial agents than E.faecalis.All enterococcal isolates were susceptible to vancomycin and linezolid.The prevalence ofβ-lactamase was 58.0% in H.influenzae and 60.3% in H.parainfluenzae.The prevalence of ESBLs-producing strains was 66.6% in E.coli and 72.0% in K.pneumoniae.The ESBLs-producing E.coli and K.pneumoniae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rates.About 43.1% and 43.2% of K.pneumoniae strains,4.5%and 4.2% of E.coli strains,21.2% and 19.6% of P.aeruginosa isolates,54.0%and 54.0% of A.baumannii strains were resistant to meropenem and imipenem,respectively.Conclusions Multi-drug-resistant bacterial strains pose a serious threat in children,which implies the importance of strengthening infection control and antimicrobial stewardship.