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中国循证儿科杂志

中国循证儿科杂志 ›› 2021, Vol. 16 ›› Issue (6): 414-420.

• 论著 • 上一篇    下一篇

中国儿童细菌耐药监测组2020年儿童细菌耐药监测

何磊燕1a,12，付盼1a,12，吴霞1b，王传清1a，俞蕙1b，许红梅2a，景春梅2b，邓继岿3a，王红梅，3a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 重庆医科大学附属儿童医院重庆，400014，a 感染科，b 检验科；3 深圳市儿童医院深圳，518026，a 感染科，b 检验科；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 温州医学院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 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（东院）开封，475099，a 感染科，b 检验科；11 吉林大学第一医院儿科吉林，130021；12 共同第一作者
  • 收稿日期:2022-01-25 出版日期:2021-12-25 发布日期:2021-12-25
  • 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 of 2020

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HE Leiyan1a, 12, FU Pan1a, 12, WU Xia1b, WANG Chuanqing1a, YU Hui1b, XU Hongmei2a, JING Chunmei2b, DENG Jikui3a, WANG Hongmei3a, 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 518026, China: a Infectious Disease Department, b Department of Medical Laboratory;
    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 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 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 Hospital Affiliated to Jilin University, Changchun 130021, China: Pediatric Department; 
    12 Cofirst authors
  • Received:2022-01-25 Online:2021-12-25 Published:2021-12-25
  • 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）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，以代表中国儿童细菌耐药监测情况。 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、鉴定方法以及抗菌药物敏感试验条件和方法，要求以统一格式上报分离到的有效菌株和细菌耐药资料，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2020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（2020）判断标准。 主要结局指标：儿科菌群分布特征及细菌耐药性变化，重点为多重耐药菌（MDROs）在儿科群体中的检出情况。 结果：共对42 786临床分离株进行监测，革兰阳性菌和阴性菌的比例分别为38.5%和61.5%。前5位分离株依次是：大肠埃希菌（16.4%）、金黄色葡萄球菌（12.6%）、肺炎链球菌（9.8%）、凝固酶阴性葡萄球菌（7.3%）和肺炎克雷伯菌（7.0%）。新生儿组前3位主要致病菌分别为金黄色葡萄球菌（19.3%）、大肠埃希菌（18.6%）和肺炎克雷伯菌（13.2%），非新生儿组分别为大肠埃希菌（16.2%）、金黄色葡萄球菌（11.7%）和肺炎链球菌（11.2%）。呼吸道标本的比例由2019年的53.9%降至2020年的45.2%。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、铜绿假单胞菌（CRPA）和鲍曼不动杆菌（CRAB）检出率分别为4.9%、9.5%和33.5%，其中CRPA在新生儿组检出率高于非新生儿组（19.4% vs 9.2%），CRAB在新生儿组的检出率低于非新生儿组（14.8% vs 37.1%）；甲氧西林耐药金黄色葡萄球菌和凝固酶阴性葡萄球菌检出率分别为31.5%和75.9%。 结论：2020年MDROs在儿童患者中的总体检出率较2019年降低，对多种抗生素的耐药率也有所降低。

关键词: 细菌, 耐药, 儿童, 中国儿童细菌耐药监测组, 2020

Abstract: Background: Chinese ISPED (Infectious Disease Surveillance of Pediatrics) was established in 2015. The data of antibiotics resistance were collected from each member hospital and summarized every year to monitor the bacterial drug resistance among Chinese children. Objective: This study 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 member hospital was required to perform the standard procedure of bacterial culture, identification and antimicrobial susceptibility test and to report the isolated strains and drugresistant bacteria. All data were analyzed to reflect the current bacterial infection and drug resistance among children in mainland China. Methods: Clinical isolates were collected from 11 tertiary children's hospitals in China from January 1st to December 31st in 2020. 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(2020). Main outcome measures: The distribution of bacteria strains and the changes of bacteria drug resistance in pediatrics, especially the multidrugresistant organisms(MDRO) among pediatric patients. Results: A total of 42,786 isolates were collected, of which 38.5% was grampositive organisms and 61.5% was gramnegative organisms. Top five pathogens were Escherichia coli (16.4%), Straphylococcus aureus(12.6%), Streptococcus pneumonia (9.8%), Coagulase negative staphylococci (7.3%) and Klebsiella pneunoniae (7.0%). Top three pathogens in the neonatal group were Staphylococcus aureus (19.3%), Escherichia coli (18.6%) and Klebsiella pneumoniae (13.2%) and top three pathogens in the nonneonatal group were Escherichia coli (16.2%), Staphylococcus aureus (11.7%) and Streptococcus pneumoniae (11.2%). The proportion of respiratory specimens decreased from 53.9% in 2019 to 45.2% in 2020. Most MDROs presented highlevel drug resistance to various antibiotics. The prevalence of Carbapenen Resistant Enterobacteriaceae (CRE) , Pseudomonas aeruginosa (CRPA) , and Acinetobacter baumannii (CRAB) was 4.9%, 9.5% and 33.5% respectively. The prevalence of CRPA was higher in the neonatal group than that in the nonneonatal group (19.4% vs 9.2%) and CRAB was just the opposite (14.8% vs 37.1%). The detection rates of MethicillinResistant Staphylococcus aureus (MRSA) and Coagulase negative staphylococci (MRCNS) were 31.5% and 75.9% respectively. Conclusion: Both the detection rates of MDROs and their antimicrobial resistance in children were decreased in 2020.

Key words: Bacteria, Antimicrobial resistance, Children, Infectious Disease Surveillance of Pediatrics, 2020