中国儿童细菌耐药监测组2023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 2023

作　　者：付盼 王传清 俞蕙[2] 吴霞[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] 周明明[7] 陈益平[8] 杨锦红[9] 李继安 王世富[11] 曹清 王星 邓慧玲[14] 蔡慧君[15] 郝建华 周宇阳 黄园园[18] 项红霞[19] 卓志强 黄美恋 FU Pan;WANG Chuanqing;YU Hui;WU Xia;XU Hongmei;JING Chunmei;DENG Jikui;WANG Hongmei;HUA Chunzhen;CHEN Yinghu;ZHOU Mingming;CHEN Yiping;YANG Jinhong;LIN Ji'an;WANG Shifu;CAO Qing;WANG Xing;DENG Huiling;CAI Huijun;HAO Jianhua;ZHOU Yuyang;HUANG Yuanyuan;XIANG Hongxia;ZHUO Zhiqiang;HUANG Meilian(Clinical Microbiology Department,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 Chonqing Medical University,Chongqing 400015,China;Department of Medical Laboratory,Children's Hospital of Chonqing Medical University,Chongqing 400015,China;Infectious Disease Department,Shenzhen Children's Hospital,Shenzhen 518034,China;Infectious Disease Department,The Children's Hospital Zhejiang University School of Medicine,Hangzhou 310005,China;Department of Medical Laboratory,The Children's Hospital Zhejiang University School of Medicine,Hangzhou 310005,China;Infectious Disease Department,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Medical Laboratory The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,China;Infectious Disease Department,Children's Hospital Affiliated to Shandong University,Jinan 250100,China;Department of Medical Laboratory,Children's Hospital Affiliated to Shandong University,Jinan 250100,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 Children's Hospital,Xi'an 710003,China;Department of Medical Laboratory,Xi'an Children's Hospital,Xi'an 710003,China;Infectious Disease Department,Children's Hospital of Kaifeng City,Kaifeng 475099,China;Department of Medical Laboratory

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]重庆医科大学附属重庆儿童医院感染科,重庆400015 [4]重庆医科大学附属重庆儿童医院检验科,重庆400015 [5]广东省深圳市儿童医院感染科,深圳518034 [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]温州医科大学第二附属医院(育婴儿童医院)感染科,温州325027 [9]温州医科大学第二附属医院(育婴儿童医院)检验科,温州325027 [10]山东大学附属儿童医院感染科,济南250100 [11]山东大学附属儿童医院检验科,济南250100 [12]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 [13]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 [14]陕西省西安市儿童医院感染科,西安710003 [15]陕西省西安市儿童医院检验科,西安710003 [16]河南省开封市儿童医院(东院)感染科,开封475099 [17]河南省开封市儿童医院(东院)检验科,开封475099 [18]吉林大学白求恩第一医院儿科,吉林130021 [19]江苏省无锡市儿童医院感染科,无锡214023 [20]福建省厦门市儿童医院感染科,厦门361006 [21]福建省厦门市儿童医院检验科,厦门361006

出　　处：《中国循证儿科杂志》2024年第4期272-280,共9页Chinese Journal of Evidence Based Pediatrics

摘　　要：背景中国儿童细菌耐药监测组(ISPED)每年对成员单位的耐药监测数据汇总和分析,以了解儿童感染性病原学变化和耐药现状。目的分析2023年我国儿童细菌感染和耐药现状,旨在指导儿童抗菌药物合理应用。设计横断面调查。方法菌株资料来源于2023年1月1日至12月31日ISPED成员单位细菌室,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(CLSI)2022年标准。主要结局指标儿科菌群分布特征及主要分离株对抗菌药物耐药性变化,多重耐药菌(MDROs)在儿科群体中的检出情况。结果2023年ISPED单位共分离到58335株临床有效菌株,革兰阳性菌和阴性菌分别占40%和60%。前5位分离株分别是:大肠埃希菌(14.5%)、肺炎链球菌(12.4%)、金黄色葡萄球菌(11.8%)、流感嗜血杆菌(10.2%)和卡他莫拉菌(6.4%)。新生儿组和非新生儿组最主要分离株分别为金黄色葡萄球菌(17%)和大肠埃希菌(14.4%)。下呼吸道是最主要的标本来源(47.1%),最主要分离株为肺炎链球菌(24.3%)和流感嗜血杆菌(19.4%)。流感嗜血杆菌和卡他莫拉菌产β-内酰胺酶的比例较高,分别为74.7%和98.6%。肺炎链球菌和化脓性链球菌对红霉素和克林霉素高度耐药。脑脊液来源和非脑脊液来源的青霉素不敏感肺炎链球菌的检出率分别为93.2%和9%。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)的检出率分别为31.2%和77.2%。碳青霉烯类耐药的肠杆菌目细菌(CRE)、铜绿假单胞菌(CR-PA)和鲍曼不动杆菌(CR-AB)检出率分别为3.7%、8.1%和30.8%。新生儿组CR-PA的检出率高于非新生儿组(19.7%vs 7.4%,P<0.01),而CR-AB检出率低于非新生儿组(23.2%vs 32.1%,P<0.05)。新生儿组CR-AB对多种抗生素如头孢哌酮/舒巴坦、阿米卡星和左氧氟沙星的耐药率均高于非新生儿组(P<0.05)�Background The Chinese Infectious Disease Surveillance of Pediatrics(ISPED)program collects and analyzes the monitoring data of antibiotics resistance from its member units annually to understand changes in pediatric infectious pathogens and resistance patterns in China.Objective To explore the status of bacterial infections and resistance in children in China for 2023,aiming to guide the rational use of antimicrobial agents in pediatrics.Design Cross-sectional survey.Methods Clinical isolates were collected from children hospitals in China enrolled in the ISPED program from January 1st to December 31st,2023.Antimicrobial susceptibility testing was carried out using a unified protocol using the Kirby-Bauer method or automated systems.Penicillin susceptibility of streptococcus pneumonia was detected by E-test,with results evaluated according to the 2022 standards of the Clinical and Laboratory Standards Institute(CLSI).Main outcome measures The distribution characteristics of bacteria strains in children,changes in antimicrobial resistance of major isolated strains,and the detection of multidrug-resistant organisms(MDROs)in the pediatric population.Results A total of 58,335 isolates were collected,of which 40%were gram-positive organisms and 60%were gram-negative.The top five pathogens were as follows,Escherichia coli(14.5%),Streptococcus pneumonia(12.4%),Staphylococcus aureus(11.8%),Haemophilus influenza(10.2%),and Moraxella catarrhalis(6.4%).The most common pathogens in neonates and non-neonates were S.aureus(17%)and E.coli(14.4%),respectively.The primary specimen was the lower respiratory tract(47.1%),and the most common pathogens were S.pneumonia(24.3%)and H.influenza(19.4%).The rates ofβ-lactamase production in Haemophilus influenzae and Moraxella catarrhalis were high,at 74.7%and 98.6%,respectively.Both S.pneumoniae and S.pyogenes showed high-resistance to erythromycin and clindamycin.The proportion of penicillin-insensitive S.pneumoniae(PNSP)from cerebrospinal fluid and non-cerebrospinal fluid was 93.2%and

关 键 词：细菌 耐药 儿童 2023 

分 类 号：R446.5[医药卫生—诊断学]