2016—2018年11所医院儿童血培养分离菌的耐药性分析

目的了解2016-2018年11所医院儿童血培养阳性细菌的分布及耐药情况。方法根据全国细菌耐药监测网技术要求,对血培养阳性分离菌进行鉴定和药敏试验,按照2018年美国临床和实验室标准化协会(CLSI)标准进行结果判读,用WHONET 5.6软件对数据进行统计分析。结果2016-2018年自血培养中共分离得病原菌14078株,其中革兰阳性菌9141株,占64.9%;革兰阴性菌4937株,占35.1%,前五位分离菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、嗜麦芽窄食单胞菌、克雷伯菌属和肠球菌属细菌。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA、MRCNS)的检出率分别为31.6%和81.4%。除四环素外,粪肠球菌对其他抗菌药物的耐药率均低于屎肠球菌,肺炎链球菌对青霉素G的耐药率仅为1.6%,未检出耐万古霉素和利奈唑胺的细菌。碳青霉烯类耐药大肠埃希菌和肺炎克雷伯菌检出率分别为4.4%和21.5%。结论儿童血培养分离菌以革兰阳性菌为主,MRSA仍然是革兰阳性菌感染中的主要问题。碳青霉烯类耐药的肠杆菌科细菌逐年增加,应加强医院感染防控和抗菌药物临床应用管理,以遏制此类菌株的传播扩散。

Antimicrobial resistance profile of the bacterial strains isolated from children's blood samples in 11 hospitals from 2016 to 2018

Objective To investigate the distribution and antibiotic resistance profile of pathogenic bacteria isolated from children’s blood samples in 11 hospitals from 2016 to 2018.Methods Bacterial identification and antimicrobial susceptibility tests were conducted according to the uniform technical program of China Antimicrobial Resistance Surveillance System(CARSS).The results were interpreted according to breakpoints of 2018 CLSI guideline.WHONET 5.6 software was used to review and analyze the data.Results A total of 14078 strains were isolated from blood samples in these hospitals from 2016 to 2018,of which gram-positive and gram-negative bacteria accounted for 64.9%(9141/14078)and 35.1%(4937/14078),respectively.The top five species were coagulase-negative Staphylococcus,Escherichia coli,Stenotrophomonas maltophilia,Klebsiella spp.and Enterococcus spp..The prevalence of methicillin-resistant strains was 31.6% in S.aureus and 81.4%in coagulase-negative Staphylococcus.E.faecalis was more sensitive to most of the antibiotics tested than E.faecium,except for tetracycline.Only 1.6% of Streptococcus pneumoniae strains were resistant to penicillin G.Vancomycin-or linezolid-resistant strains were not found in grampositive bacteria.Carbapenems-resistant strains accounted for 4.4% and 21.5% in E.coli and K.pneumoniae isolates,respectively.Conclusions Gram-positive bacteria are the main pathogens isolated from blood in children,especially MRSA.The prevalence of carbapenem-resistant Enterobacteriaceae strains has been increasing in recent years.It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents to prevent the spread of such organisms.