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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (5): 341-348.DOI: 10.3969/j.issn.1673-5501.2023.05.003

• 论著 • 上一篇    下一篇

中国儿童细菌耐药监测组2022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，陈益平5a，杨锦红5b，林爱伟6a，王世富6b，曹清7a，王星7b，邓慧玲8a，曹三成8b，郝建华9a，高巍9b，黄园园10，项红霞11，卓志强12a，黄美恋12b   

  1. 1 复旦大学附属儿科医院上海，201102，a 临床检验中心细菌室，b 感染科；2 重庆医科大学附属重庆儿童医院重庆，400015，a 感染科，b 检验科；3 广东省深圳市儿童医院感染科深圳，518034；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 温州医学院附属育英儿童医院温州，325027，a 感染科，b 检验科；6 山东大学附属儿童医院济南，250100，a 感染科，b 检验科；7 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；8 陕西省西安市儿童医院
    西安，710003，a 感染科，b 检验科；9 河南省开封市儿童医院（东院）开封，475099，a 感染科，b 检验科；10 吉林大学白求恩第一医院儿科吉林，130021；11 江苏省无锡市儿童医院感染科无锡，214023；12 福建省厦门市儿童医院厦门，361006，a 感染科，b 检验科


  • 收稿日期:2023-08-01 修回日期:2023-10-02 出版日期:2023-10-25 发布日期:2023-10-25
  • 通讯作者: 王传清，俞蕙

Antimicrobial resistance profile of clinical strains isolated from children in China: Report from the ISPED program in 2022

FU Pan1a, WANG Chuanqing1a, YU Hui1b, WU Xia1b, XU Hongmei2a, JING Chunmei2b, DENG Jikui3, WANG Hongmei3, HUA Chunzhen4a, CHEN Yinghu4a, CHEN Xuejun4b, CHEN Yiping5a, YANG Jinhong5b, LIN Aiwei6a, WANG Shifu6b, CAO Qing7a, WANG Xing7b, DENG Huiling8a, CAO Sancheng8b, HAO Jianhua9a, GAO Wei9b, HUANG Yuanyuan10, XIANG Hongxia11, ZHUO Zhiqiang12a, HUANG Meilian12b   

  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 400015, China, a Infectious Disease Department, b Department of Medical Laboratory; 3 Infectious Disease Department, Shenzhen Children's Hospital, Shenzhen 518034, China; 4 The Children's Hospital Zhejiang University School of Medicine, Hangzhou 310005, China, a Infectious Disease Department, b Department of Medical Laboratory; 5 Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China, a Infectious Disease Department, b Department of Medical Laboratory; 6 Children's Hospital Affiliated to Shandong University, Jinan 250100, China, a Infectious Disease Department, b Department of Medical Laboratory; 7 Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China, a Infectious Disease Department, b Department of Medical Laboratory; 8 Xi'an Children's Hospital, Xi'an 710003, China, a Infectious Disease Department, b Department of Medical Laboratory; 9 Children's Hospital of Kaifeng City, Kaifeng 475099, China, a Infectious Disease Department, b Department of Medical Laboratory; 10 Pediatric Department, The First Bethune Hospital of Jilin University, Changchun 130021, China; 11 Infectious Disease Department, Children's Hospital of Wuxi City, Wuxi 214023, China; 12 Children's Hospital of Xiamen City, Xiamen 361006, China, a Infectious Disease Department, b Department of Medical Laboratory

  • Received:2023-08-01 Revised:2023-10-02 Online:2023-10-25 Published:2023-10-25
  • 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）每年对纳入的12家成员单位的儿童耐药监测数据进行汇总和分析，了解儿童感染性病原学变化和耐药现状。 目的：分析2022年我国儿童细菌感染和耐药现状，旨在指导儿童抗菌药物合理应用。 设计：横断面调查。 方法：菌株来源于2022年1月1日至12月31日ISPED成员单位细菌室，抗菌药物敏感试验采用自动化细菌鉴定及药敏分析仪或扩散纸片法，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（CLSI）2022年标准。 主要结局指标：儿童人群菌群分布特征及主要分离株对抗菌药物耐药性变化，多重耐药菌（MDROs）的检出情况。 结果：2022年ISPED单位共分离到50 399株临床菌株，革兰阳性菌和阴性菌的比例分别为38.8%和61.2%。前10位分离株分别是：大肠埃希菌（14.3%）、流感嗜血杆菌（11.8%）、金黄色葡萄球菌（11.4%）、肺炎链球菌（11.3%）、卡他莫拉菌（7.3%）、凝固酶阴性葡萄球菌（6.8%）、肺炎克雷伯菌（5.3%）、铜绿假单胞菌（4.4%）、鲍曼不动杆菌（2.3%）及粪肠球菌（2.1%）。大肠埃希菌是新生儿、学龄期和青春期儿童主要分离菌，流感嗜血杆菌是婴儿主要分离菌，肺炎链球菌是幼儿和学龄前期儿童主要分离菌。青霉素不敏感菌株（PNSP）在脑脊液和非脑脊液来源肺炎链球菌中的比例分别为88.9%和6.6%。甲氧西林耐药金黄色葡萄球菌（MRSA）、碳青霉烯类耐药的肠杆菌目细菌（CRE）、铜绿假单胞菌（CR-PA）和鲍曼不动杆菌（CR-AB）检出率分别为32.8%、4.5%、7.6%和24.3%。MRSA、CRE和CR-PA在新生儿组检出率分别为33.2%、6.4%和11.3%，高于非新生儿组的32.6%、4.2%和7.5%；CR-AB在新生儿组的检出率为10.9%，低于非新生儿组的26.3%。 结论：2022年MDROs检出率较往年呈现下降趋势，应高度警惕和防范MRSA、CRE和CR-PA在新生儿中的定植、感染与传播。

关键词: 细菌, 耐药, 儿童, 中国儿童细菌耐药监测组, 2022

Abstract: Background：Chinese Infectious Disease Surveillance of Pediatrics (ISPED) program collected and summarized the data of antibiotics resistance from 12 member hospitals every year to monitor the bacterial drug resistance and pathogen changes among Chinese children. Objective：To investigate the antimicrobial resistance profiles of pathogens and bacteria infection in Chinese children and guide the reasonable use of antibiotics. Design：A cross-sectional survey. MethodsFrom January 1st to December 31rd in 2022, clinical isolates were collected from children hospitals in China enrolled in ISPED program. 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 set by Clinical and Laboratory Standards Institute (CLSI) in 2022. Main outcome measures：Distribution of bacteria strains in children, changes of bacteria drug resistance to isolated strains, and detection of multi-drug resistant organisms (MDROs). Results：A total of 50,399 isolates were collected, of which 38.8% was gram-positive organisms and 61.2% was gram-negative organisms. Top ten pathogens were as follows, Escherichia coli (14.3%), Haemophilus influenza (11.8%), Straphylococcus aureus (11.4%), Streptococcus pneumonia (11.3%), Moraxella catarrhalis (7.3%), Coagulase-negative staphylococci (6.8%), Klebsiella pneunoniae (5.3%), Pseudomonas aeruginosa (4.4%), Acinetobacter baumannii(2.3%) and Enterococcus faecalis (2.1%). E. coli was the most common pathogen in neonates and children over 5 years old. H. influenza was the major pathogen in children from the age of >28 days to 1 year. S. pneumoniae was the main pathogenic bacteria in children at the age of 1 to 5 years old. The proportion of penicillin-insensitive S. pneumoniae (PNSP) from cerebrospinal fluid and non-cerebrospinal fluid were 88.9% and 6.6%, respectively. The ratios of methicillin-resistant S. aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CR-PA), carbapenem-resistant A. baumannii (CR-AB) were 32.8%, 4.5%, 7.6% and 24.3%, respectively. The detection rates of MRSA, CRE and CR-PA in the neonatal group were 33.2%, 6.4% and 11.3%, much higher than those in the non-neonatal group (32.6%、4.2% and 7.5%). CR-AB in the neonatal group accounted for 10.9%, which was lower than that in the non-neonatal group (26.3%). Conclusions：The detection rate of MDROs in 2022 shows the continuous decrease compared to the previous years. More attention should be paid to the colonization, infection and spread of MRSA, CRE and CR-PA in the neonatal population.

Key words: Bacteria, Antimicrobial resistance, Children, Infectious Disease Surveillance for Pediatrics, 2022