2019—2021年住院儿童多重耐药菌分布及耐药性分析  

AN ANALYSIS OF DISTRIBUTION AND DRUG RESISTANCE OF MULTIDRUG-RESISTANT ORGANISMS IN HOSPITALIZED CHILDREN FROM 2019 TO 2021

作　　者：张丽[1] 孙雪荣[2] 徐莉莉[2] 薛爱丽 张东峰[4] ZHANG Li;SUN Xuerong;XU Lili;XUE Aili;ZHANG Dongfeng(Hospital Infection-Control Department of Women and Children’s Hospital Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属妇女儿童医院院感科,山东青岛266000 [2]青岛大学附属妇女儿童医院检验科,山东青岛266000 [3]青岛大学附属妇女儿童医院小婴儿科,山东青岛266000 [4]青岛大学医学院,山东青岛266000

出　　处：《青岛大学学报(医学版)》2023年第5期735-739,共5页Journal of Qingdao University(Medical Sciences)

基　　金：青岛市卫生健康委员会资助项目(2021-W-JZD129)。

摘　　要：目的对2019—2021年青岛某医院住院儿童多重耐药菌(MDRO)分布特点及耐药性进行分析,为该地区儿童MDRO的预防与治疗提供参考依据。方法分析2019年1月1日—2021年12月31日住院儿童送检标本分离的MDRO情况,对检出的MDRO的分布、耐药性进行分析。结果2019—2021年共检出MDRO 917株,其中占前4位的分离菌株分别为产超广谱β-内酰胺酶大肠埃希菌(ESBLs-EC)440株(47.98%)、耐甲氧西林金黄色葡萄球菌(MRSA)234株(25.52%)、产超广谱β-内酰胺酶肺炎克雷伯菌(ESBLs-KP)148株(16.14%)、耐碳青霉烯肺炎克雷伯菌(CRKP)36株(3.93%)。CRKP、ESBLs-KP、耐碳青霉烯类鲍曼不动杆菌(CRAB)、耐碳青霉烯类铜绿假单胞菌(CRPA)检出率比较差异有统计学意义(χ^(2)=6.276~19.335,P<0.01)。检出MDRO前3位的标本分别是痰液、脓液、血液,占比分别为39.04%、28.90%、12.00%。3年间检出MDRO最多的科室为儿内科(368株,40.13%),耐碳青霉烯类大肠埃希菌(CREC)、CRKP、MRSA检出最高的科室为儿内科,ESBLs-EC检出最高的为儿外科,ESBLs-KP检出较高的科室为儿内科和重症监护室(ICU),CRAB、CRPA主要为儿童监护室检出。CREC对米诺环素、替加环素、多黏菌素B、美罗培南、亚胺培南敏感,敏感率>90.00%;CRAB对米诺环素、替加环素、多黏菌素B敏感率为100.00%;CRPA对米诺环素、多黏菌素B敏感率为100.00%;MRSA对万古霉素、利奈唑胺、替加环素的敏感率为100.00%;CREC对米诺环素、替加环素、美罗培南、亚胺培南、厄他培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星敏感,敏感率>90.00%;MRSA是住院儿童检出的革兰染色阳性的优势菌群,其对红霉素、克林霉素的耐药率在90.00%以上。结论2019—2021年检出的MDRO以产ESBLs-EC、MRSA、ESBLs-KP为主,ICU、儿内科应纳入MDRO感染防控管理的重点科室。Objective To analyze the distribution characteristics and drug resistance of multidrug-resistant organisms(MDRO)among hospitalized children in a hospital of Qingdao,China from 2019—2021,and to provide a reference for the prevention and treatment of MDRO in children in this region.Methods We analyzed the distribution and drug resistance of MDRO strains isolated from samples of hospitalized children from January 1,2019 to December 31,2021.Results From 2019 to 2021,a total of 917 MDRO strains were detected.The top four isolated strains were extended-spectrum beta-lactamase-producing Escherichia coli(ESBL-EC,440 strains(47.98%)),methicillin-resistant Staphylococcus aureus(MRSA,234 strains(25.52%)),ESBL-producing Klebsiella pneumoniae(ESBL-KP,148 strains(16.14%)),and carbapenem-resistant Klebsiella pneumoniae(CRKP,36 strains(3.93%)).There were significant differences in the detection rates of CRKP,ESBL-KP,carbapenem-resistant Acinetobacter baumannii(CRAB),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)(χ^(2)=6.276-19.335,P<0.01).The top three MDRO-positive specimens were sputum,pus,and blood,accounting for 39.04%,28.90%,and 12.00%,respectively.During the three years,MDRO strains were most frequently from the department of pediatric internal medicine(368 strains,40.13%);carbapenem-resistant Escherichia coli(CREC),CRKP,and MRSA strains were most frequently from the department of pediatric internal medicine;ESBL-EC strains were most frequently from the department of pediatric surgery;ESBL-KP strains were mostly from the department of pediatric internal medicine and intensive care unit(ICU);CRAB and CRPA strains were mainly from the pediatric intensive care unit.CREC strains were sensitive to minocycline,tigecycline,polymyxin B,meropenem,and imipenem,with the sensitivity rates greater than 90.00%.The sensitivity rates of CRAB to minocycline,tigecycline,and polymyxin B were 100.00%.CRPA strains were 100.00%sensitive to minocycline and polymyxin B.MRSA strains were 100.00%sensitive to vancomycin,linezolid,and tigec

关 键 词：儿童 住院 抗药性 多种 细菌 抗药性 

分 类 号：R446.5[医药卫生—诊断学] R37[医药卫生—临床医学]