中国儿童细菌耐药监测组2018年儿童细菌感染及耐药监测

目的 了解目前中国大陆儿童细菌感染和耐药现状。方法 菌株资料来源于2018年1月1日至12月31日中国大陆11所三级甲等儿童医院。细菌抗生素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(CLSI)2017年判断标准。结果 共对62 212临床分离株进行监测,革兰阳性菌和阴性菌的比例分别为42.2%和57.8%。前5位分离株分别是:肺炎链球菌(12.9%)、大肠埃希菌(12.4%)、流感嗜血杆菌(11.8%)、金黄色葡萄球菌(10.3%)和卡他莫拉菌(7.2%)。金黄色葡萄球菌是新生儿最主要的致病菌(17.0%)。57.0%的标本来源于呼吸道,其中下呼吸道主要致病菌为肺炎链球菌,上呼吸道主要致病菌为化脓性链球菌。肠杆菌科细菌中耐碳青霉烯类药物(CRE)的比例为8.7%,其中新生儿组CRE检出率远高于非新生儿组(16.8% vs 7.2%)。CRE总体耐药率较高,对Ⅰ~Ⅳ类头孢类和酶抑制剂复合制剂耐药率均>85%。鲍曼不动杆菌中,碳青霉烯类耐药的鲍曼不动杆菌(CR-ab)比例为63.2%,非新生儿组中检出率(69.7%)高于新生儿组(35.2%)。碳青霉烯类耐药的铜绿假单胞菌的比例为27.2%,在新生儿组和非新生儿组检出率分别为25.0%和27.3%,两组差异无统计学意义。耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的比例分别为34.9%和77.3%。化脓性链球菌对青霉素不敏感率0.1%,非脑脊液来源的肺炎链球菌中青霉素不敏感菌株(PNSP)比例为21.3%。流感嗜血杆菌β-内酰胺酶阳性检出率为61.1%。结论 呼吸道感染占儿童细菌性感染的首位。碳青霉烯类耐药菌对多种抗生素呈现高水平耐药,新生儿组CRE比例高于非新生儿组,CR-ab比例低于非新生儿组。

Antimicrobial resistance profile of clinical isolates in pediatric hospitals in China: report from the ISPED Surveillance Program, 2018

Objective This study is aimed to investigate the antimicrobial resistance profiles of pathogens in Chinese children.Methods Clinical isolates were collected from 11 tertiary children hospitals in China in 2018. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) 2017 breakpoints. Penicillin susceptibility of streptococcus pneumonia was detected by E-test.Results A total of 62,212 isolates were collected, of which 42.2% was gram-positive organisms and 57.8% was gram-negative organisms. Top-five pathogens were as follows, Streptococcus pneumonia (12.9%), Escherichia coli (12.4%), Haemophilus influenza (11.8%), Straphylococcus aureus (10.3%), and Moraxella catarrhalis (7.2%). In neonatal group, Straphylococcus aureus was the primary pathogen (17.0%). More than half of pathogens (57.0%) were seperated from respiratory tract, Streptococcus pneumonia and Streptococcus pyogenes were the primary pathogens isolated in lower and upper respiratory tract respectively. Carbapenem resistance Enterobacteriaceae(CRE) accounted for 8.7%. The detection rate of CRE in neonatal group was 16.8%, much higher than that in non-neonatal group (7.2%). CRE strains represented high-level resistances to many antibiotics. Carbapenem resistant Acinetobacter baumannii (CR-ab) was 63.2% in total and the rate in neonatal group was 35.2%, much lower than than in non-neonatal group (69.7%). Carbapenem resistant Pseudomonas aeruginosa (CR-pae) was 27.2% and showed no difference between neonatal (25.0%) and non-neonatal (27.3%) groups. The Methicillin-resistant Staphylococcus aureus (MRSA) and Coagulase negative staphylococci (MRCNS) were 34.9% and 77.3% respectively. We detected 0.1% penicillin non-susceptible β-hemolytic Streptococcus pyogenes. The penicillin non-susceptible rates of Streptococcus pneumonia (PNSP) from non-cerebrospinal fluid was 21.3%. The β-lactamase positive rate of Haemophilus pneumonia isolates was increased to 61.1%.Conclusion Respiratory infection was the most common pediatric infections. Carbapenem-resistant bacteria presented high-level resistance to various antibiotics. In neonatal group, CRE was higher than that in non-neonatal group but CR-ab was lower than that in non-neonatal group.