2018年四川省儿童患者细菌耐药监测分析

摘要：目的 了解2018年四川省儿童患者主要病原菌分布及对常用抗菌药物耐药性，为临床合理选择抗菌药物提供依据。方法 收集2018年全国细菌耐药监测网四川省成员单位报告的儿童患者病原菌数据并进行分析总结。结果 2018年共分离出细菌46387株，其中革兰阳性菌19012株(占41.0%)，以肺炎链球菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌为主，检出率分别是17.3%、15.7%和2.1%；革兰阴性菌27375株(占59.0%)，主要是流感嗜血菌、大肠埃希菌和黏膜炎莫拉菌，检出率分别是21.2%、10.4%和8.3%。非脑脊液标本分离的肺炎链球菌对红霉素的耐药率高达95.9%。耐甲氧西林金黄色葡萄球菌的检出率为26.7%，耐甲氧西林凝固酶阴性葡萄球菌的检出率为79.1%，未发现万古霉素和利奈唑胺耐药肺炎链球菌和葡萄球菌。粪肠球菌对万古霉素的耐药率为0.6%，未发现替考拉宁耐药的粪肠球菌；屎肠球菌对万古霉素的耐药率为0.6%，对替考拉宁的耐药率为2.1%。流感嗜血菌对氨苄西林、复方磺胺甲噁唑以及头孢克肟的耐药率高。黏膜炎莫拉菌对阿奇霉素的非敏感率为72.5%。肺炎克雷伯菌对亚胺培南、美罗培南耐药率分别为7.7%和11.6%。结论 2018年四川省儿童细菌感染的主要病原菌中，耐红霉素的肺炎链球菌、耐甲氧西林凝固酶阴性葡萄球菌、耐氨苄西林的流感嗜血菌以及耐碳青霉烯的肺炎克雷伯菌检出率高，需加强感染防控。

Distribution and the antimicrobial resistance profile of the clinical bacterial strains isolated from children patients of Sichuan province in 2018

Abstract Objective To investigate the distribution and the antimicrobial resistance profile of common pathogens isolated from children patients of Sichuan province in 2018, and provide the information about the reasonable use of antimicrobial agents. Methods All the bacterial strains isolated from children patients were collected by members of Sichuan province in China Antimicrobial Resistance Surveillance System in 2018, and were then analyzed. Results The total number of strains were 46,387. The most common Gram-positive isolates were Streptococcus pneumoniae, Staphylococcus aureus, and coagulase-negative Staphylococcus, which accounted for 17.3%, 15.7%, and 2.1%, respectively. While the most frequently isolated Gram-negative microorganisms were Haemophilus influenzae, Escherichia coli, and Moraxella catarrhalis, which accounted for 21.2%, 10.4%, and 8.3%, respectively. The resistance rate of Streptococcus pneumonia isolated from the non-cerebrospinal fluid to erythromycin was 95.9%. The resistance rates of Staphylococcus aureus and coagulase-negative Staphylococcus to oxacillin were 26.7% and 79.1%. S. pneumoniae and staphylococcal strains resistant to vancomycin or linezolid were not found. The resistance rate of Enterococcus faecalis to vancomycin was 0.6%, and Enterococcus faecalis strains resistant to teicoplanin were not found. The resistance rates of Enterococcus faecium to vancomycin and teicoplanin were 0.6% and 2.1%, respectively. The resistance rates ofHaemophilus influenzae to ampicillin, compound sulfamethoxazole, and cefixime were high. The resistance rates of K. pneumoniae to carbapenems and meropenem had increased to 7.7% and 11.6% in 2018. Conclusion Among the major pathogens of bacterial infections in children in Sichuan province in 2018, the detection rates of erythromycin-resistant Streptococcus pneumoniae, methicillin-resistant coagulase negative Staphylococcus, ampicillin-resistant Haemophilus influenzae and carbapenems-resistant Klebsiella pneumoniae were high, which implied the importance of strengthening the infection control.