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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (5): 355-362.DOI: 10.3969/j.issn.1673-5501.2022.05.006

• 论著 • 上一篇    下一篇

中国儿童细菌耐药监测组2021年儿童细菌耐药监测

付盼1a王传清1a,俞蕙1b,吴霞1b,许红梅2a,景春梅2b,邓继岿3,王红梅3,华春珍4a,陈英虎4a,陈学军4b,张婷5a,张泓5b,陈益平6a,杨锦红6b,林爱伟7a,王世富7b,曹清8a,王星8b,邓慧玲9a,曹三成9b,郝建华10a,高巍10b,黄园园11,项红霞12,卓志强13a,黄美恋13b


  

  1.  1 复旦大学附属儿科医院上海，201102，ａ细菌室，ｂ感染科；2 重庆医科大学附属儿童医院重庆，400014，ａ感染科，ｂ检验科；3 广东省深圳市儿童医院检验科深圳，518026；4 浙江大学医学院附属儿童医院杭州，310005，ａ感染科，ｂ检验科；5 上海交通大学医学院附属儿童医院上海，200040，ａ消化感染科，ｂ检验科；6 温州医科大学附属育英儿童医院温州，325027，ａ感染科，ｂ检验科；7 山东大学齐鲁儿童医院济南，250100，ａ感染科，ｂ检验科；8 上海交通大学医学院附属上海儿童医学中心上海，200127，ａ感染科，ｂ检验科；9 陕西省西安市儿童医院西安，710043，ａ感染科，ｂ检验科；10 河南省开封市儿童医院开封，475099，ａ感染科，ｂ检验科；11 吉林大学白求恩第一医院儿科长春，130021；12 江苏省无锡市儿童医院感染科无锡，214023；13 复旦大学附属儿科医院厦门分院厦门，361006，ａ感染科，ｂ检验科

  • 收稿日期:2022-09-01 修回日期:2022-09-15 出版日期:2022-10-25 发布日期:2022-10-25
  • 通讯作者: 王传清;俞蕙

Antimicrobial resistance profile of clinical strains isolated from children in China: A report from the ISPED program in 2021

FU Pan1a, WANG Chuanqing1a, YU Hui1b, WU Xia1b, XU Hongmei2a, JING Chunmei2b, DENG Jikui3, WANG Hongmei3, HUA Chunzhen4a, CHEN Yinghu4a, CHEN Xuejun4b, ZHANG Ting5a, ZHANG Hong5b, CHEN Yiping6a, YANG Jinhong6b, LIN Aiwei7a, WANG Shifu7b, CAO Qing8a, WANG Xing8b, DENG Huiling9a, CAO Sancheng9b, HAO Jianhua10a, GAO Wei10b, HUANG Yuanyuan11, XIANG Hongxia12, ZHUO Zhiqiang13a, HUANG Meilian13b   

  1. 1 Children's Hospital of Fudan University, Shanghai 201102, China, a Clinical Microbiology Department, b Infectious Disease Department; 2 Children's Hospital of Chonqing Medical University, Chongqing 400014, China, a Infectious Disease Department, b Department of Medical Laboratory; 3 Shenzhen Children's Hospital, Shenzhen 518026, China, Infectious Disease Departmen; 4 The Children's Hospital Zhejiang University School of Medicine, Hangzhou 310005, China, a Infectious Disease Department, b Department of Medical Laboratory; 5 Children's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200040, China, a Digestive and Infectious Disease Department, b Department of Medical Laboratory; 6 Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China, a Infectious Disease Department, b Department of Medical Laboratory; 7 Qilu Children's Hospital of Shandong University, Jinan 250100, China, a Infectious Disease Department, b Department of Medical Laboratory; 8 Shanghai Children's  Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China, a Infectious Disease Department, b Department of Medical Laboratory; 9 Xi'an Children's Hospital, Xi'an 710043, China, a Infectious Disease Department, b Department of Medical Laboratory; 10 Children's Hospital of Kaifeng City, Kaifeng 475099, China, a Infectious Disease Department, b Department of Medical Laboratory; 11 The First Bethune Hospital of Jilin University, Changchun 130021, China, Pediatric Department; 12 Children's Hospital of Wuxi City, Wuxi 214023, Infectious Disease Department; 13 Children's Hospital of Xiamen City, Xiamen 361006, a Infectious Disease Department, b Department of Medical Laboratory
  • Received:2022-09-01 Revised:2022-09-15 Online:2022-10-25 Published:2022-10-25
  • Contact: WANG Chuanqing，email:chuanqing523@163.com；YU Hui，email:yuhui4756@sina.com

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摘要： 背景：中国儿童细菌耐药监测组（ISPED）每年对成员单位的耐药监测数据进行汇总和分析，以监测中国儿童感染性病原学变迁和耐药情况。 目的：对我国儿童细菌感染和耐药现状进行监测汇总，以期指导儿童抗生素合理应用。 设计：横断面调查。 方法：菌株资料来源于2021年1月1日至12月31日国内13所三级甲等儿童教学医院，细菌抗菌药物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性试验采用Etest法，结果判断采用美国临床实验室标准化委员会2021年标准。各成员单位统一细菌培养、鉴定方法、抗菌药物敏感试验条件和方法，每年以统一格式上报分离到的有效菌株和细菌耐药资料，进行数据汇总和统计分析。 主要结局指标：儿科菌群分布特征及主要病原菌耐药性变化。 结果：2021年ISPED单位共分离到63 508株临床有效菌株，革兰阳性菌和革兰阴性菌的比例分别为39.9%和60.1%。前10位分离株分别是：大肠埃希菌12.7%、肺炎链球菌12.3%、金黄色葡萄球菌11.6%、流感嗜血杆菌11.4%、卡他莫拉菌6.5%、肺炎克雷伯菌 5.2%、铜绿假单胞菌4.0%、表皮葡萄球菌3.7%、鲍曼不动杆菌 2.4%和化脓性链球菌2.1%。不同年龄组的主要分离菌分布不同，其中金黄色葡萄球菌在新生儿中分离率最高（18.7%），肺炎链球菌是>28 d至5岁儿童主要分离菌（13.6%~20.8%），大肠埃希菌是>5岁儿童最主要分离菌（22.4%）。青霉素不敏感的肺炎链球菌为9.6%。多重耐药菌（MDROs）对临床多种抗生素呈现高水平耐药，碳青霉烯类耐药的肠杆菌目细菌、肺炎克雷伯菌、铜绿假单胞菌（CRPA）和鲍曼不动杆菌（CRAB）检出率分别为4.6%、14.8%、6.7%和30.7%，CRPA在新生儿组检出率较高，CRAB在非新生儿组检出率较高，CRPA和CRAB对多种抗生素耐药率在非新生儿组中均明显高于新生儿组。甲氧西林耐药金黄色葡萄球菌检出率为33.2%。 结论：2021年MDROs在ISPED中总体检出率较往年降低，对多种抗生素的耐药率也有所降低，应警惕新生儿群体中CRPA的感染与定植。

关键词: 细菌, 耐药, 儿童, 中国儿童细菌耐药监测组, 2021

Abstract: Background：Chinese Infectious Disease Surveillance of Pediatrics(ISPED)was established in 2015. The data of antibiotics resistance were collected from each hospital and summarized every year to monitor the infectious etiology changes and bacterial drug resistance among Chinese children. Objective：This study is aimed to investigate the bacterial infectious and antimicrobial resistance profiles of pathogens in Chinese children and guide the reasonable use of antibiotics. Design：A crosssectional survey. Methods：Clinical isolates were collected from 13 tertiary children hospitals in China from January 1st to December 31st in 2021. Antimicrobial susceptibility testing was carried out according to a unified protocol using KirbyBauer method or automated systems. Penicillin susceptibility of streptococcus pneumonia was detected by Etest. All of the antimicrobial susceptibility testing results were interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) 2021. All members used the standard methods to perform bacterial culture,identification and antimicrobial susceptibility test and reported the isolated effective strains and bacterial resistance data in a structured format every year for data summary and statistical analysis. Main outcome measures：Detect the distribution of bacteria strains in children and the changes of bacteria drug resistance. Results：A total of 63 508 isolates were collected, of which 39.9% was grampositive organisms and 60.1% was gramnegative organisms. Top ten pathogens were as follows, Escherichia coli (12.7%), Streptococcus pneumonia (12.3%), Straphylococcus aureus (11.6%), Haemophilus influenza (11.4%), Moraxella catarrhalis (6.5%), Klebsiella pneunoniae (5.2%), Pseudomonas aeruginosa (4.0%), Staphylococcus epidermidis (3.7%), Acinetobacter baumannii (2.4%) and Streptococcus pyogenes (2.1%). The distribution of the primary pathogenic bacteria in different age groups was different. Among them, Saureus had the highest isolation rate in neonates (18.7%), and S.pneumoniae was the main pathogenic bacteria in children aged from >28 d to 5 years old, arranging from 13.6% to 20.8%. E.coli was the most common pathogen in children over 5 years old (22.4%). The proportion of penicillininsensitive S.pneumoniae (PNSP) decreased to 9.6%. Multidrugresistant bacteria (MDROs) showed high levels of resistance to a variety of clinical antibiotics, and the ratios of carbapenemresistant Enterobacteriaceae (CRE), K.pneumoniae (CRKP), P.aeruginosa (CRPA), A.baumannii (CRAB) were 4.6%, 14.8%, 6.7% and 30.7%, respectively. The proportions of CRPA and CRAB showed a decreasing trend in the past 6 years. The former had a higher detection rate in the neonatal group, while the latter had a higher detection rate in the nonneonatal group. Moreover, the resistance rates of CRPA and CRAB to multiple antibiotics were significantly higher in the nonneonatal group than in the neonatal group. Methicillinresistant Saureus(MRSA) was relatively stable, with a detection rate of 33.2% in 2021. Conclusion：The detection rate of MDROs in 2021 was lower than previous years, and the resistance ratio of MDROs also decreased in pediatric patients. We must pay attention to the infection and colonization of CRPA in the neonatal population.

Key words: Bacteria, Antimicrobial resistance, Children, Infectious Disease Surveillance for Pediatrics, 2021