2017—2022年江苏省某儿童医院ICU患儿痰培养病原菌分布及耐药性变迁的分析  

Analysis of the changes of bacterial spectrum and drug resistance in sputum culture of ICU children in a hospital of pediatric in Jiangsu Province from 2017 to 2022

作　　者：黄辉[1] 魏佳 申汉俊 谭秋霞 薛建[1] 汪呈 Huang Hui;Wei Jia;Shen Hanjun;Tan Qiuxia;Xue Jian;Wang Cheng(Department of Laboratory Medicine,Children′s Hospital of Soochow University,Suzhou 215025,China;Blood Transfusion Department,Children′s Hospital of Soochow University,Suzhou 215025,China)

机构地区：[1]苏州大学附属儿童医院检验科,苏州215025 [2]苏州大学附属儿童医院输血科,苏州215025

出　　处：《中华预防医学杂志》2024年第10期1534-1540,共7页Chinese Journal of Preventive Medicine

摘　　要：目的探讨江苏省苏州地区2017—2022年重症监护室儿童下呼吸道感染(LRTI)病原菌分布及耐药特征变化。方法采用横断面观察性研究方法,收集2017年1月至2022年12月在苏州大学附属儿童医院重症监护室的1182例LRTI患儿,年龄1.00(0.25,4.00)岁,男性728例,女性454例。收集痰液标本采用细胞培养法检测病原菌,通过MALDI-TOF质谱仪进行细菌鉴定,并联合VITEK2 Compact全自动分析系统和纸片法进行药敏试验。运用χ^(2)检验或Fisher确切概率法比较2017—2019年和2020—2022年ICU儿童痰培养阳性菌的分布和耐药性改变。结果痰培养总体检出率42.06%(1182/2810),检出前三位的菌株为金黄色葡萄球菌(25.63%,303/1182)、鲍曼不动杆菌(13.62%,161/1182)和流感嗜血杆菌(13.28%,157/1182)。2020—2022年鲍曼不动杆菌(17.90%vs.11.02%,χ^(2)=11.17,P=0.001),尤其是耐碳青霉烯类鲍曼不动杆菌(43.70%vs.23.50%,χ^(2)=15.21,P<0.001)比例较2017—2019年显著上升;而2020—2022年流感嗜血杆菌(8.50%vs.16.19%,χ^(2)=14.27,P<0.001)、肺炎链球菌(8.50%vs.15.92%,χ^(2)=13.42,P<0.001)和产超广谱-内酰胺酶大肠埃希菌(8.89%vs.18.00%,χ^(2)=5.45,P=0.025)比例较2017—2019年明显下降。药敏结果显示,2020—2022年鲍曼不动杆菌对亚胺培南(χ^(2)=4.43,P=0.035)和左氧氟沙星(χ^(2)=12.53,P<0.001)耐药性较2017—2019年明显增加,而对米诺环素(χ^(2)=8.34,P=0,004)耐药率减低。2020—2022年大肠埃希菌对哌拉西林/他唑巴坦(χ^(2)=8.29,P=0.008)、头孢哌酮/舒巴坦(χ^(2)=5.07,P=0.024)的耐药率显著增加;肺炎克雷伯菌对一代、二代头孢菌素耐药率始终保持在60%以上,对喹诺酮类和碳青霉烯类药物敏感。2020—2022年金黄色葡萄球菌对左氧氟沙星(耐药率2.31%,7/303)和磺胺甲恶唑/甲氧苄啶(耐药率4.95%,15/303)仍保持高度敏感。结论2020—2022年苏州大学附属儿童医院ICU患儿痰培养鲍曼不动杆菌检出率和耐药率明显升高,大肠�ObjectiveTo investigate the changes of the distribution and drug resistance profile of bacteria from ICU children with lower respiratory tract infection(LRTI)in Suzhou City,Jiangsu Province from 2017 to 2022.MethodsFrom January 2017 to December 2022,a cross-sectional observational study on the bacterial spectrum analysis among intensive care unit(ICU)children with LRTI was conducted in Children′s Hospital of Soochow University.The bacteria was cultivated by culture methods from sputum samples,and identified by MALDI-TOF mass spectrometry.Drug sensitivity tests were performed by the VITEK2 Compact fully automated analysis system and the paper slide method.Theχ^(2) test or Fisher′s exact probability was used to analyze the changes of the distribution of sputum culture-positive bacteria and drug resistance in ICU children.ResultsThe overall detection rate of sputum culture was 42.06%(1182/2810).Staphylococcus aureus(25.63%,303/1182),Acinetobacter baumannii(13.62%,161/1182)and Haemaphilus influenzae(13.28%,157/1182)were the top three.Proportions of Acinetobacter baumannii(17.90%vs.11.02%,χ^(2)=11.17,P=0.001),especially carbapenem-resistant Acinetobacter baumannii(43.70%vs.23.50%,χ^(2)=15.21,P<0.001)increased significantly from 2020 to 2022.However,the proportions of Haemophilus influenzae(8.50%vs.16.19%,χ^(2)=14.27,P<0.001),Streptococcus pneumoniae(8.50%vs.15.92%,χ^(2)=13.42,P<0.001)and extended-spectrum-lactamase producing Escherichia coli(8.89%vs.18.00%,χ^(2)=5.45,P=0.025)decreased.Drug resistant results showed that Acinetobacter baumannii was obviously more resistant to imipenem(χ^(2)=4.43,P=0.035)and levofloxacin(χ^(2)=12.53,P<0.001),while more sensitive to minocycline(χ^(2)=8.34,P=0.004).Escherichia coli showed a significant increase in resistance to piperacillin tazobactam(χ^(2)=8.29,P=0.008)and cefoperazone sulbactam(χ^(2)=5.07,P=0.024)from 2020 to 2022;Klebsiella pneumoniae consistently maintained a resistance rate of more than 60%to first and second-generation cephalosporins,and remain suscept

关 键 词：危重症儿童 痰培养 多重耐药 

分 类 号：R720.597[医药卫生—急诊医学] R446.5[医药卫生—儿科]