2018-2020年深圳市儿童医院临床分离细菌分布及耐药性监测  

The distribution and antibiotic resistance profiles of clinically isolated bacteria in Shenzhen Children's Hospital from 2018 to 2020

作　　者：孟青 崔晓燕[1] 周林涛 颜慧敏 姜含芳 叶炳均 陈虹宇[1] 孙丽芳[1] 陈运生[1] MENG Qing;CUI Xiaoyan;ZHOU Lintao;YAN Huimin;JIANG Hanfang;YE Bingjun;CHEN Hongyu;SUN Lifang;CHEN Yunsheng(Department of Laboratory Medicine,Shenzhen Children's Hospital,Shenzhen Guangdong 518038,China)

机构地区：[1]深圳市儿童医院检验科,广东深圳518038

出　　处：《中国感染与化疗杂志》2022年第3期314-321,共8页Chinese Journal of Infection and Chemotherapy

摘　　要：目的持续监测临床分离菌的菌种分布及耐药性。方法对深圳市儿童医院2018—2020年临床分离细菌进行鉴定并采用纸片扩散法和自动化仪器法进行细菌药物敏感性试验。结果三年共分离细菌21925株,每年约7300株,其中革兰阳性菌占38.3%,革兰阴性菌占61.7%。肺炎链球菌非脑膜炎分离株中青霉素中介株(PISP)占0.1%~0.6%,未检出青霉素耐药株(PRSP)。耐甲氧西林葡萄球菌中MRSA和MRCNS三年分别占各自菌种的35.4%、32.8%、26.2%和83.2%、83.2%、68.3%,呈逐年递减。屎肠球菌对多数受试抗菌药物的耐药率均高于粪肠球菌,发现2株利奈唑胺耐药粪肠球菌,未发现万古霉素耐药肠球菌(VRE)。未发现青霉素耐药无乳链球菌,但草绿色链球菌对青霉素的耐药率为25.8%。大肠埃希菌和肺炎克雷伯菌中碳青霉烯类耐药菌株的检出率较低,三年分别为0.6%、0.3%、0.3%和3.2%、6.2%、4.5%。碳青霉烯类耐药的铜绿假单胞菌和鲍曼不动杆菌(CRPA和CRAB)有增长趋势,三年分别占各自菌种的6.3%、7.1%、9.5%和10.4%、6.3%、16.0%;卡他莫拉菌和流感嗜血杆菌中产β内酰胺酶的检出率三年分别为98.2%、97.6%、97.9%和51.7%、58.9%、47.7%,产酶株对多种受试抗菌药物的耐药率高于不产酶株。结论提高病原菌的正确诊断,加强细菌耐药性监测结合医院感染防控,依据药敏试验结果合理使用抗生素,可延缓细菌耐药性的发展。Objective To analyze the distribution and antibiotic resistance profiles of clinical isolates in a children’s hospital.Methods Clinical isolates were collected in Shenzhen Children's Hospital from 2018 to 2020.The strains were tested for their antimicrobial susceptibility to antimicrobial agents using Kirby-Bauer method and automated systems.Results A total of 21925 bacterial strains were isolated over the 3-year period,including Gram-positive bacteria(38.3%)and Gram-negative bacteria(61.7%).The prevalence of PISP was 0.1%-0.6%in the non-meningitis isolates of Streptococcus pneumoniae.No PRSP strain was detected.The prevalence of MRSA and MRCNS was 35.4%and 83.2%in 2018,32.8%and 83.2%in 2019,but decreased to 26.2%and 68.3%in 2020.Enterococcus faecium showed higher resistance rates to most of the antimicrobial agents tested than Enterococcus faecalis.Two E.faecalis strains were found resistant to linezolid.No vancomycin-resistant Enterococcus was isolated.No penicillin-resistant strains of Streptococcus agalactiae were detected,while 25.8%of the Streptococcus viridans isolates were resistant to penicillin.The prevalence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae was low,specifically 0.6%and 3.2%in 2018,0.3%and 6.2%in 2019,0.3%and 4.5%in 2020.The prevalence of carbapenem-resistant Pseudomonas aeruginosa(CRPA)and Acinetobacter baumannii(CRAB)was 6.3%and 10.4%in 2018,7.1%and 6.3%in 2019,9.5%and 16.0%in 2020.The prevalence ofβ-lactamase-producing Moraxella catarrhalis and Haemophilus influenzae was 98.2% and 51.7% in 2018, 97.6% and 58.9% in 2019, 97.9% and 47.7% in 2020. The β-lactamase-producing strains demonstrated higher resistance rates to most of the antimicrobial agents tested than the non-β-lactamase-producing strains. Conclusions Accurate etiological diagnosis combined with antimicrobial resistance surveillance and hospital infection control, and rational antimicrobial therapy based on susceptibility testing are helpful for containing bacterial resistance.

关 键 词：细菌耐药性监测 药物敏感性试验 甲氧西林耐药葡萄球菌 碳青霉烯类耐药肠杆菌目细菌 

分 类 号：R378[医药卫生—病原生物学]