2016—2018年河南省儿童医院细菌分布及耐药性分析

目的 了解河南省儿童医院2016—2018年临床分离菌株的分布及常用抗菌药物的耐药情况，为儿科临床合理用药提供依据。方法 选择2016—2018年所有临床分离菌株，采用Phoenix 100微生物分析仪和纸片扩散法进行药敏实验，按照历年CLSI标准判读药敏结果，用WHONET5.6软件进行耐药性分析。 结果 2016—2018年共收集临床非重复分离株21404株，其中革兰阳性菌7772株，占36.3%，革兰阴性菌13632株，占63.7%。无菌体液标本共分离出致病菌2312株，排在前三位的细菌为凝固酶阴性葡萄球菌、大肠埃希菌和肺炎克雷伯菌。 3105株非脑脊液分离的肺炎链球菌中青霉素不敏感率为0.5%。耐甲氧西林金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)平均检出率分别为34.2%和72.0%；MRSA和MRCNS对绝大多数测试抗菌药物的耐药率均显著高于甲氧西林敏感株金黄色葡萄球菌(MSSA)和凝固酶阴性葡萄球菌(MSCNS)。对万古霉素和利奈唑胺不敏感的葡萄球菌未检出。检出耐万古霉素屎肠球菌1株，未发现对万古霉素不敏感的粪肠球菌。流感嗜血菌β-内酰胺酶阳性率为53.7%，除了对复方磺胺甲噁唑的耐药率高于80.0%外，对大多数抗菌药物比较敏感。 2016—2018年大肠埃希菌产超广谱β-内酰胺酶(ESBL)的检出率依次为70.4%、72.1%和66.6%，大肠埃希菌对碳青霉烯仍高度敏感，3年来其对碳青霉烯类药物的耐药率都低于10.0%。2016—2018年肺炎克雷伯菌产ESBL检出率依次为61.3%、75.6%和72.0%，对亚胺培南的耐药率为39.3%、32.7%和43.1%，对美罗培南的历年耐药率为40.4%、30.8%和43.2%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为22.8%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60.5%。结论

Antimicrobial resistance surveillance of Henan Children’s Hospital in 2016—2018

Objective To determine the resistance profile of clinical isolates collected at Henan Children’s Hospital to commonly used antibiotics, so enabling pediatricians to make evidence-based decision on medication. Methods All clinical isolates collected from 2016—2018 were tested. Antimicrobial susceptibility was tested using the Kirby-Bauer method and Phoenix 100 Automated Microbiology Systems, and data were analyzed according to CLSI 2017 breakpoints using WHONET5.6 software. Results A total of 21,404 isolates were analyzed, of which 36.3% were Gram positive organisms and 63.7% were Gram negative organisms. A total of 2,312 pathogenic bacteria were isolated from sterile body fluid samples. The top three bacteria were coagulase-negative Staphylococcus, Escherichia coli, and Klebsiella pneumoniae. The penicillin insensitivity rate of 3,105 strains of Streptococcus pneumoniae isolated from non-cerebrospinal fluid was 0.5%. The prevalence of methicillin-resistant strains was 34.2% in S. aureus (MRSA) and 72.0% in coagulase negative Staphylococcus (MRCNS). No staphylococcal strains resistant to vancomycin or linezolid were found. One E. faecium strain was identified as resistant to vancomycin. Beta-lactamase was positive in 53.7% of the H. influenzae isolates. The prevalence of ESBL-producing strains of E. coli was 70.4% in 2015, 72.1% in 2016 and 66.6% in 2017. E. coli was still highly susceptible to carbapenem antibiotics, less than 10% being resistant each year. The prevalence of ESBL-producing strains of K. pneumoniae was 61.3% in 2015, 75.6% in 2016 and 72.0% in 2017, and up to 37.7% and 38.1% of K. pneumoniae isolates were resistant to imipenem and meropenem, respectively. The resistantance rates declined over the three years period. About 22.8% and 19.6% of P. aeruginosa strains were resistant to imipenem and meropenem, respectively, and about 60.5% of A. baumannii strains were resistant to imipenem and meropenem, respectively. Conclusions The prevalence of MRSA and CRKP were still on the rise in pediatric inpatients over this period, suggesting the widespread presence of extensively drug-resistant strains. Our findings highlight the need to standardize anti-infection treatment, use antibiotics rationally, strengthen the monitoring of bacterial resistance, and to proactively control nosocomial