2017-2019年某院住院儿童肠杆菌科细菌分布及耐药分析

摘要：目的 了解某院住院儿童肠杆菌科细菌的检出和耐药情况，指导临床抗菌药物合理应用。方法 收集某院2017年1月1日至2019年12月31日住院儿童标本分离出的肠杆菌科细菌资料，对病原菌分布、标本来源、耐药情况以及ESBLs阳性和CRE菌株检出情况进行分析。结果 共分离得到儿童肠杆菌科细菌558株，其中新生儿96株，非新生儿462株。呼吸道标本占74.9%，分泌物标本8.06%，无菌体液5.91%，尿液和肠道标本均为5.56%。儿童株肠杆菌科细菌检出率前3位的是大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌。大肠埃希菌和肺炎克雷伯菌对头孢他啶之外的第一代至第三代头孢菌素耐药率均高于40%。阴沟肠杆菌对第三代头孢菌素耐药率均低于30%，但是对于碳青霉烯类抗菌药物亦有11%~14%的耐药率。未发现对替加环素耐药的肠杆菌科细菌。ESBLs阳性肠杆菌科细菌比例为19.5%，CRE比例为8.4%。结论 儿童肠杆菌科细菌分布广泛，耐药形式严峻，新生儿肺炎克雷伯菌耐药率高于非新生儿，新生儿菌株ESBLs阳性率及CRE检出率亦较非新生儿高，应高度重视肠杆菌科细菌及其耐药性的监测，合理应用抗菌药物。

A hospital analysis of distribution and drug resistance of Enterobacteriaceae in hospitalized children from 2017 to 2019

Abstract Objective To understand the detection and drug resistance of Enterobacteriaceae strains in hospitalized children, and to guide the rational application of antibacterial drugs. Methods The data of Enterobacteriaceae bacteria isolated from children’s specimens were collected in a hospital from January 1, 2017 to December 31, 2019, and analyzed the distribution of bacteria, the source of specimens, drug resistance, and the detection of ESBLs positive and CRE. Results A total of 558 strains of Enterobacteriaceae from children were isolated, of which 96 were newborns and 462 were non-neonatal. Respiratory tract specimens accounted for 74.9%, secretion specimens accounted for 8.06%, sterile body fluids accounted for 5.91%, and urine and intestinal specimens both accounted for 5.56%. The top three detection rates of Enterobacteriaceae in children were Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae. Escherichia coli and Klebsiella pneumoniae were significantly resistant to cephalosporins. Except for Ceftazidime, the resistance rates to the first to the third generation cephalosporins were higher than 40%. The resistance rate of Enterobacter cloacae to the third-generation cephalosporin was less than 30%, but it also had a resistance rate of 11%-14% to carbapenems. No Enterobacteriaceae resistant to Tigecycline was found. The proportion of ESBLs positive Enterobacteriaceae was 19.5%, and the proportion of CRE was 8.4%. Conclusion Enterobacteriaceae were widely distributed in hospitalized children, and the drug resistance was severe. The drug resistance rate of Klebsiella pneumoniae in newborns was higher than that of non-neonatal. The positive rate of ESBLs and the detection rate of CRE in newborns were also higher thannon-neonatal. We should pay attention to Enterobacteriaceae and its drug resistance, and clinicians should choose reasonable antibacterial drugs based on the prevalence and drug resistance of children in our