2011—2022年重庆地区儿童患者临床分离肺炎链球菌的耐药性变迁  

Changing antimicrobial resistance profiles of Streptococcus pneumoniae isolated from pediatric patients in Chongqing area from 2011 to 2022

作　　者：赵洁[1] 余小燕 景春梅[1] ZHAO Jie;Yu Xiaoyan;JING Chunmei(Department of Laboratory Medicine,Children's Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院检验科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿童感染与免疫罕见病重庆市重点实验室,重庆400014

出　　处：《中国感染与化疗杂志》2025年第1期24-29,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的 了解重庆地区儿童患者临床分离肺炎链球菌对常用抗菌药物耐药性变迁情况,为临床合理使用抗菌药物和预防医院感染提供参考依据。方法 回顾分析2011—2022年从临床感染患者标本中检出肺炎链球菌的临床特征,用商品化药敏测试自动化仪器和E试验进行药敏测定,按CLSI 2022年折点标准判读药敏结果。结果 12年共分离肺炎链球菌26 668株,在临床分离病原菌中占16.0%,在革兰阳性菌中占46.4%;主要分离自呼吸道标本(97.1%),其次是血液标本(1.5%)。肺炎链球菌在婴儿组的分离率最高(38.2%),其次是幼儿组(32.4%)、学龄前期(22.9%)、学龄期(5.6%)、青春期(0.6%)、新生儿期(0.4%)。临床分离肺炎链球菌中自脑脊液分离38株,约占0.1%,对青霉素全耐药,对头孢噻肟、美罗培南的耐药率分别为35.7%、32.4%。临床非脑脊液分离26 630株,占总数的99.9%,青霉素敏感株(PSSP)、中介株(PISP)、耐药株(PRSP)的检出率分别为71.9%(16 083株)、25.1%(5 610株)、3.0%(674株);在PRSP中,婴幼儿和学龄前期时段检出率高于其他年龄段。非脑脊液肺炎链球菌对红霉素、克林霉素、四环素耐药率均在95%以上,对左氧氟沙星、莫西沙星、利福平的耐药率较低,分别为0.2%、0.2%、0.1%;未检出耐万古霉素、利奈唑胺的肺炎链球菌。结论 不同标本类型和不同年龄组儿童中肺炎链球菌的分离率和耐药情况有差异,青霉素耐药率呈逐年下降趋势,可为重庆地区儿童肺炎链球菌感染经验性治疗提供参考。Objective To investigate the changing antimicrobial resistance profiles of Streptococcus pneumoniae isolates from children in Chongqing area from 2011 to 2022,and to provide evidence for rational use of antibiotics and prevention of nosocomial infections.Methods The clinical data of S.pneumoniae strains isolated from pediatric patients during 2011-2022 were retrospectively analyzed.Antimicrobial susceptibility testing was performed with commercial automated systems and E-test.The results were interpreted according to the breakpoints in CLSI document(2022 edition).Results A total of 26668 strains of S.pneumoniae were isolated during the 12-year period.The proportion of S.pneumoniae was 16.0%in the total pathogenic bacterial isolates and 46.4%in all the gram-positive bacterial pathogens.S.pneumoniae strains were mainly isolated from respiratory specimens(97.1%),followed by blood samples(1.5%).The highest proportion of S.pneumoniae isolates was in infants(38.2%),followed by toddlers(32.4%),preschool age(22.9%),school age(5.6%),adolescents(0.6%)and neonates(0.4%).All of the 38 strains of nonmeningitis S.pneumoniae(0.1%)isolated from cerebrospinal fluid were resistant to penicillin.Overall,35.7%and 32.4%of these strains were resistant to cefotaxime and meropenem,respectively.The majority of S.pneumoniae(99.9%,26630/26668)were nonmeningitis isolates.The prevalence of penicillin-susceptible(PSSP),-intermediate(PISP),and-resistant(PRSP)strains was 71.9%(16083),25.1%(5610),and 3.0%(674),respectively.The prevalence of PRSP in infants and preschool children was higher than that in other age groups.The nonmeningitis S.pneumoniae isolates showed higher than 95%resistance rate to erythromycin,clindamycin and tetracycline,but 0.2%,0.2%and 0.1%resistance rate to levofloxacin,moxifloxacin and rifampicin,respectively.No S.pneumoniae strains were found resistant to vancomycin or linezolid.Conclusions The proportion and antimicrobial resistance profles of S.pneumoniae strains isolated from pediatric patients varied with age group an

关 键 词：肺炎链球菌 耐药性 变迁 儿童 

分 类 号：R378.14[医药卫生—病原生物学]