中国儿童细菌耐药监测组2019年儿童细菌耐药监测  

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

作　　者：付盼 何磊燕 王传清 俞蕙 许红梅[3] 景春梅[4] 邓继岿[5] 赵瑞珍[6] 华春珍[7] 陈英虎[7] 陈学军[8] 张婷[9] 张泓[10] 陈益平[11] 杨锦红[12] 林爱伟[13] 王世富[14] 曹清 王星 邓慧玲[17] 曹三成[18] 郝建华 高巍 黄园园[21] FU Pan;HE Leiyan;WANG Chuanqing;YU Hui;XU Hongmei;JING Chunmei;DENG Jikui;ZHAO Ruizhen;HUA Chunzhen;CHEN Yinghu;CHEN Xuejun;ZHANG Ting;ZHANG Hong;CHEN Yiping;YANG Jinhong;LIN Aiwei;WANG Shifu;CAO Qing;WANG Xing;DENG Huiling;CAO Sancheng;HAO Jianhua;GAO Wei;HUANG Yuanyuan(Microbiology Department of Clinical Medical Laboratory,Children's Hospital of Fudan University,Shanghai 201102,China;Infectious Disease Department,Children's Hospital of Fudan University,Shanghai 201102,China;Infectious Disease Department,Children's Hospital of Chongqing Medical University,Chongqing 400014,China;Department of Medical Laboratory,Children's Hospital of Chongqing Medical University,Chongqing 400014,China;Infectious Disease Department,Shenzhen Children's Hospital,Shenzhen 518038,China;Department of Medical Laboratory,Shenzhen Children's Hospital,Shenzhen 518038,China;Infectious Disease Department,The Children's Hospital Zhejiang University School of Medicine Hangzhou 310003,China;Department of Medical Laboratory,The Children's Hospital Zhejiang University School of Medicine Hangzhou 310003,China;Digestive and Infectious Disease Department,Children's Hospital of Shanghai Jiaotong University Shanghai 200040,China;Department of Medical Laboratory,Children's Hospital of Shanghai Jiaotong University Shanghai 200040,China;Infectious Disease Department,Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Medical Laboratory,Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,China;Infectious Disease Department,Qilu Children's Hospital of Shandong University,Jinan 250022,China;Department of Medical Laboratory,Qilu Children's Hospital of Shandong University,Jinan 250022,China;Infectious Disease Department,Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Medical Laboratory,Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Infectious Disease Department,Xi'an Childr

机构地区：[1]复旦大学附属儿科医院临床检验中心细菌室,上海201102 [2]复旦大学附属儿科医院感染科 [3]重庆医科大学附属儿童医院感染科,重庆400014 [4]重庆医科大学附属儿童医院检验科,重庆400014 [5]广东省深圳市儿童医院感染科,深圳518038 [6]广东省深圳市儿童医院检验科,深圳518038 [7]浙江大学医学院附属儿童医院感染科,杭州310003 [8]浙江大学医学院附属儿童医院检验科,杭州310003 [9]上海交通大学医学院附属上海市儿童医院消化感染科,上海200062 [10]上海交通大学医学院附属上海市儿童医院检验科,上海200062 [11]浙江省温州医学院附属育英儿童医院感染科,温州325027 [12]浙江省温州医学院附属育英儿童医院检验科,温州325027 [13]山东省济南市儿童医院感染科,济南250022 [14]山东省济南市儿童医院检验科,济南250022 [15]上海交通大学医学院附属上海儿童医学中心感染科,上海200127 [16]上海交通大学医学院附属上海儿童医学中心检验科,上海200127 [17]陕西省西安市儿童医院感染科,西安710003 [18]陕西省西安市儿童医院检验科,西安710003 [19]河南省开封市儿童医院(东院)感染科,开封475099 [20]河南省开封市儿童医院(东院)检验科,开封475099 [21]吉林大学第一医院儿科,长春130021

出　　处：《中国循证儿科杂志》2021年第1期43-49,共7页Chinese Journal of Evidence Based Pediatrics

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76287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 aerugi

关 键 词：细菌 耐药 儿童 中国儿童细菌耐药监测组 2019 

分 类 号：R446.5[医药卫生—诊断学]