中国儿童细菌耐药监测组2020年儿童细菌耐药监测

背景：中国儿童细菌耐药监测组（ISPED）2015年成立后，每年对成员单位的耐药监测数据进行汇总和分析，以代表中国儿童细菌耐药监测情况。 目的：对我国儿童细菌感染和耐药现状进行监测汇总，以期指导儿童抗生素合理应用。 设计：横断面调查，ISPED要求成员单位统一细菌培养、鉴定方法以及抗菌药物敏感试验条件和方法，要求以统一格式上报分离到的有效菌株和细菌耐药资料，汇总数据后统计中国大陆儿童细菌感染和耐药现状。 方法：菌株资料来源于2020年1月1日至12月31日国内11所三级甲等儿童教学医院，细菌抗菌药物敏感性试验采用自动化仪器法及KB纸片法，肺炎链球菌青霉素药物敏感性试验采用E test法，结果判断采用美国临床实验室标准化委员会（2020）判断标准。 主要结局指标：儿科菌群分布特征及细菌耐药性变化，重点为多重耐药菌（MDROs）在儿科群体中的检出情况。 结果：共对42 786临床分离株进行监测，革兰阳性菌和阴性菌的比例分别为38.5%和61.5%。前5位分离株依次是：大肠埃希菌（16.4%）、金黄色葡萄球菌（12.6%）、肺炎链球菌（9.8%）、凝固酶阴性葡萄球菌（7.3%）和肺炎克雷伯菌（7.0%）。新生儿组前3位主要致病菌分别为金黄色葡萄球菌（19.3%）、大肠埃希菌（18.6%）和肺炎克雷伯菌（13.2%），非新生儿组分别为大肠埃希菌（16.2%）、金黄色葡萄球菌（11.7%）和肺炎链球菌（11.2%）。呼吸道标本的比例由2019年的53.9%降至2020年的45.2%。MDROs对临床多种抗生素呈现高水平耐药，碳青霉烯类耐药的肠杆菌目细菌、铜绿假单胞菌（CR PA）和鲍曼不动杆菌（CR AB）检出率分别为4.9%、9.5%和33.5%，其中CR PA在新生儿组检出率高于非新生儿组（19.4% vs 9.2%），CR AB在新生儿组的检出率低于非新生儿组（14.8% vs 37.1%）；甲氧西林耐药金黄色葡萄球菌和凝固酶阴性葡萄球菌检出率分别为31.5%和75.9%。 结论：2020年MDROs在儿童患者中的总体检出率较2019年降低，对多种抗生素的耐药率也有所降低。

Antimicrobial resistance profile of clinical strains isolated from children in China: A report from the ISPED program of 2020

Background: Chinese ISPED (Infectious Disease Surveillance of Pediatrics) was established in 2015. The data of antibiotics resistance were collected from each member hospital and summarized every year to monitor the bacterial drug resistance among Chinese children. Objective: This study aimed to investigate the antimicrobial resistance profiles of pathogens in Chinese children and guide the reasonable use of antibiotics. Design: This is a cross sectional survey. Every member hospital was required to perform the standard procedure of bacterial culture, identification and antimicrobial susceptibility test and to report the isolated strains and drug resistant bacteria. All data were analyzed to reflect the current bacterial infection and drug resistance among children in mainland China. Methods: Clinical isolates were collected from 11 tertiary children's hospitals in China from January 1st to December 31st in 2020. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby Bauer method or automated systems. Penicillin susceptibility of streptococcus pneumonia was detected by E test. All of the antimicrobial susceptibility testing results were interpreted according to the criteria of Clinical and Laboratory Standards Institute(2020). Main outcome measures: The distribution of bacteria strains and the changes of bacteria drug resistance in pediatrics, especially the multidrug resistant organisms(MDRO) among pediatric patients. Results: A total of 42,786 isolates were collected, of which 38.5% was gram positive organisms and 61.5% was gram negative organisms. Top five pathogens were Escherichia coli (16.4%), Straphylococcus aureus(12.6%), Streptococcus pneumonia (9.8%), Coagulase negative staphylococci (7.3%) and Klebsiella pneunoniae (7.0%). Top three pathogens in the neonatal group were Staphylococcus aureus (19.3%), Escherichia coli (18.6%) and Klebsiella pneumoniae (13.2%) and top three pathogens in the non neonatal group were Escherichia coli (16.2%), Staphylococcus aureus (11.7%) and Streptococcus pneumoniae (11.2%). The proportion of respiratory specimens decreased from 53.9% in 2019 to 45.2% in 2020. Most MDROs presented high level drug resistance to various antibiotics. The prevalence of Carbapenen Resistant Enterobacteriaceae (CRE) , Pseudomonas aeruginosa (CR PA) , and Acinetobacter baumannii (CR AB) was 4.9%, 9.5% and 33.5% respectively. The prevalence of CR PA was higher in the neonatal group than that in the non neonatal group (19.4% vs 9.2%) and CR AB was just the opposite (14.8% vs 37.1%). The detection rates of Methicillin Resistant Staphylococcus aureus (MRSA) and Coagulase negative staphylococci (MRCNS) were 31.5% and 75.9% respectively. Conclusion: Both the detection rates of MDROs and their antimicrobial resistance in children were decreased in 2020.