中国儿童细菌耐药监测组2020年儿童细菌耐药监测  

Antimicrobial resistance profile of clinical strains isolated from children in China:A report from the ISPED program of 2020

作　　者：何磊燕 付盼 吴霞[2] 王传清 俞蕙[2] 许红梅[3] 景春梅[4] 邓继岿[5] 王红梅[5] 华春珍[6] 陈英虎[6] 陈学军[7] 张婷[8] 张泓[9] 陈益平[10] 杨锦红[11] 林爱伟 王世富 曹清 王星 邓慧玲[16] 曹三成[17] 郝建华 高巍 黄园园[20] HE Leiyan;FU Pan;WU Xia;WANG Chuanqing;YU Hui;XU Hongmei;JING Chunmei;DENG Jikui;WANG Hongmei;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(Children's Hospital of Fudan University,Shanghai 201102,China,Microbiology Department of Clinical Medical Laboratory;Children's Hospital of Fudan University,Shanghai 201102,China,Infectious Disease Department;Children's Hospital of Chongqing Medical University,Chongqing 400014,China,Infectious Disease Department;Children's Hospital of Chongqing Medical University,Chongqing 400014,China,Department of Medical Laboratory;Shenzhen Children's Hospital,Shenzhen 518026,China,Infectious Disease Department;The Children's Hospital Zhejiang University School of Medicine Hangzhou 310005,China,Infectious Disease Department;The Children's Hospital Zhejiang University School of Medicine Hangzhou 310005,China,Department of Medical Laboratory;Children's Hospital of Shanghai Jiaotong University Shanghai 200040,China,Digestive and Infectious Disease Department;Children's Hospital of Shanghai Jiaotong University Shanghai 200040,China,Department of Medical Laboratory;Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,China,Infectious Disease Department;Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,China,Department of Medical Laboratory;Qilu Children's Hospital of Shandong University,Jinan 250100,China,a Infectious Disease Department;Qilu Children's Hospital of Shandong University,Jinan 250100,China,Department of Medical Laboratory;Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China,a Infectious Disease Department;Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China,Department of Medical Laboratory;Xi'an Children's Hospital,Xi'an 710043,China,a Infectious Disease Department;Xi'an Children's Hospital,Xi'an 710043

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,上海201102 [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]深圳市儿童医院感染科,深圳518026 [6]浙江大学医学院附属儿童医院感染科,杭州310005 [7]浙江大学医学院附属儿童医院检验科,杭州310005 [8]上海交通大学医学院附属儿童医院消化感染科,上海200040 [9]上海交通大学医学院附属儿童医院检验科,上海200040 [10]温州医学院附属育英儿童医院感染科,温州325027 [11]温州医学院附属育英儿童医院检验科,温州325027 [12]山东大学齐鲁儿童医院感染科,济南250100 [13]山东大学齐鲁儿童医院检验科,济南250100 [14]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 [15]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 [16]西安市儿童医院感染科,西安710043 [17]西安市儿童医院检验科,西安710043 [18]河南省开封市儿童医院(东院)感染科,开封475099 [19]河南省开封市儿童医院(东院)检验科,开封475099 [20]吉林大学第一医院儿科,吉林130021

出　　处：《中国循证儿科杂志》2021年第6期414-420,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42786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�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 China's Mainland.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 pne

关 键 词：细菌 耐药 儿童 中国儿童细菌耐药监测组 2020 

分 类 号：R446.5[医药卫生—诊断学] R725.1[医药卫生—临床医学]