中国循证儿科杂志 ›› 2021, Vol. 16 ›› Issue (1): 43-50.DOI: 10.3969/j.issn.1673-5501.2021.01.002

• 论著 • 上一篇    下一篇

中国儿童细菌耐药监测组 2019年儿童细菌耐药监测

付盼1a,c, 何磊燕1a,c, 王传清1a, 俞蕙1b, 许红梅2a, 景春梅2b, 邓继岿3a, 赵瑞珍3b, 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   

  1. 1 复旦大学附属儿科医院,a 临床检验中心细菌室,b 感染科 上海,201102;
    2 重庆医科大学附属儿童医院,a 感染科,b 检验科 重庆,400014;
    3 广东省深圳市儿童医院,a 感染科,b 检验科 深圳,518038;
    4 浙江大学医学院附属儿童医院,a 感染科,b 检验科 杭州,310003;
    5 上海交通大学医学院附属上海市儿童医院,a 消化感染科,b 检验科 上海,200062;
    6 浙江省温州医学院附属育英儿童医院,a 感染科,b 检验科 温州,325027;
    7 山东省济南市儿童医院,a 感染科,b 检验科 济南,250022;
    8 上海交通大学医学院附属上海儿童医学中心,a 感染科,b 检验科 上海,200127;
    9 陕西省西安市儿童医院,a 感染科,b 检验科 西安,710003;
    10 河南省开封市儿童医院(东院),a 感染科,b 检验科 开封,475099;
    11 吉林大学第一医院儿科 长春,130021;c 共同第一作者
  • 收稿日期:2021-01-14 修回日期:2021-01-25 出版日期:2021-02-25 发布日期:2021-03-22
  • 通讯作者: 王传清,email:chuanqing523@163.com;俞蕙,email:yuhui4756@sina.com

Antimicrobial resistance profile of clinical isolates in pediatric hospitals in China: report from the ISPED Surveillance Program in 2019

FU Pan1a,c, HE Leiyan1a,c, WANG Chuanqing1a, YU Hui1b, XU Hongmei2a, JING Chunmei2b, DENG Jikui3a, ZHAO Ruizhen3b, 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   

  1. 1 Children's Hospital of Fudan University, Shanghai 201102, China: a Microbiology Department of Clinical Medical Laboratory, b Infectious Disease Department;
    2 Children's Hospital of Chongqing Medical University, Chongqing 400014, China: a Infectious Disease Department, b Department of Medical Laboratory;
    3 Shenzhen Children's Hospital, Shenzhen 518038, China: a Infectious Disease Department, b Department of Medical Laboratory;
    4 The Children's Hospital Zhejiang University School of Medicine Hangzhou 310003, China: a Infectious Disease Department, b Department of Medical Laboratory;
    5 Children's Hospital of Shanghai Jiaotong University 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 250022, 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 Hospital Affiliated to Jilin University, Changchun 130021, China: Pediatric Department; c Co-first authors
  • Received:2021-01-14 Revised:2021-01-25 Online:2021-02-25 Published:2021-03-22
  • Contact: WANG Chuanqing,email:chuanqing523@163.com,YU Hui,email:yuhui4756@sina.com

摘要: 背景 中国儿童细菌耐药监测组(ISPED)2015年成立后,每年对成员单位的耐药监测数据进行汇总和分析,以此代表中国监测儿童细菌耐药情况。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,ISPED要求成员单位统一细菌培养、鉴定方法、抗菌药物敏感实验条件和方法,要求以统一格式上报分离到的有效菌株和细菌耐药情况,汇总数据后统计中国大陆儿童细菌感染和耐药现状。方法 菌株资料来源于2019年1月1日至12月31日国内11所三级甲等儿童教学医院,细菌抗生素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)2019年判断标准。主要结局指标 观察儿科菌群分布特征及细菌耐药性变化,重点监测多重耐药菌在儿科群体中的检出情况。结果 共对76 287临床分离株进行监测,革兰阳性菌和阴性菌分别占41.0%和59.0%。前5位分离株分别是:大肠埃希菌(12.5%)、肺炎链球菌(11.5%)、流感嗜血杆菌(11.5%)、金黄色葡萄球菌(11.2%)和肺炎克雷伯菌(6.9%),其中金黄色葡萄球菌是新生儿人群最主要分离菌,非新生儿人群最主要分离菌是肺炎链球菌。多重耐药菌(MDROs)在儿童中较为普遍,碳青霉烯类耐药的肠杆菌科细菌(CRE)、铜绿假单胞菌(CR-PA)和鲍曼不动杆菌(CR-AB)检出率分别为8.7%、23.2%和54.0%,其中CRE在新生儿人群检出率高于非新生儿人群(11.7% vs 7.6%),CR-PA和CR-AB在新生儿人群的比例低于非新生儿人群(19.2% vs 23.3%,30.4% vs 57.7%);甲氧西林耐药金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)检出率分别为35.0%和76.4%。呼吸道是CRE、CR-PA、CR-AB和MRSA的最主要标本来源。MDROs对临床多种抗生素呈现高水平耐药,其中CR-AB对临床监测的多种抗菌药物耐药率均>70%。流感嗜血杆菌β-内酰胺酶阳性检出率为63.9%。结论 MDROs在儿童患者分离菌株中较为普遍,建立有效的多学科协作机制遏制儿童细菌耐药发生十分必要。

关键词: 细菌, 耐药, 儿童, 中国儿童细菌耐药监测组, 2019

Abstract: Background Chinese Inspect Survey of Pediatric Consortium(ISPED) Surveillance program was established in 2015. The data of antibiotics resistance were collected from each hospital of ISPED and summarized every year to monitor the bacterial drug resistance among Chinese children. Objective This study is aimed to investigate the antimicrobial resistance profiles of pathogens in Chinese children and guide the reasonable use of antibiotics. Design This is a cross-sectional survey. Every hospital conducted the standard procedure of bacterial culture, identification and antimicrobial susceptibility test. The bacterial information and antibiotics resistance data were collected by lead hospital every year. All data were analyzed to reflect the current bacterial infection and drug resistance among children. Methods Clinical isolates were collected from 11 tertiary children hospitals in China in 2019. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) 2019 breakpoints. Penicillin susceptibility of streptococcus pneumonia was detected by E-test. Main outcome measures Monitor and detect the distribution of bacteria strains in children and the changes of bacteria drug resistance, especially the multi-drug resistant bacteria among pediatric patients. Results A total of 76,287 isolates were collected, of which 41.0% was gram-positive organisms and 59.0% was gram-negative organisms. Top-five pathogens were as follows, Escherichia coli (12.5%), Streptococcus pneumonia (11.5%), Haemophilus influenza (11.5%), Straphylococcus aureus (11.2%), and Klebsiella pneunoniae (6.9%). Straphylococcus aureus and Streptococcus pneumonia was the primary pathogen in neonatal group and non-neonatal group respectively. Multi-drug resistant organisms (MDROs) were very common in children. The detection rate of Carbapenem resistance Enterobacteriaceae (CRE), Pseudomonas aeruginosa (CR-PA) and Acinetobacter baumannⅡ (CR-AB) was 8.7%, 23.2% and 54.0% respectively. CRE was higher in neonatal group (11.7%) than non-neonatal group (7.6%), while CR-PA and CR-AB was lower in neonatal group (19.2% and 30.4%) than non-neonatal group (23.2% and 57.7%). The rates of Methicillin-resistant Staphylococcus aureus (MRSA) and Coagulase negative staphylococci (MRCNS) were 35.0% and 76.4% respectively. Most of MDROs (CRE, CR-PA, CR-AB and MRSA) were seperated from respiratory tract. MDROs presented high-level drug resistances, especially CR-AB presenting >70% resistance to most antibiotics. The β-lactamase positive rate of Haemophilus influenza isolates was 63.9%. Conclusion MDROs were very common in children and it's necessary to establish an effective Multiple Disciplinary Team (MDT) to control the antimicrobial resistance in pediatric group.

Key words: Bacteria, Antimicrobial resistance, Children, Inspect Survey of Pediatrics, 2019