2016年儿童细菌耐药监测

摘要

目的 了解我国儿童细菌耐药现状.方法 现况调查.2016年1月1日至12月31日,细菌来源于国内10所三级甲等儿童教学医院,细菌抗菌药物敏感性试验采用仪器法,肺炎链球菌青霉素药物敏感试验采用E-test法,革兰阴性杆菌美罗培南药物敏感性试验采用纸片扩散法,结果判断采用美国临床实验室标准化委员会(CLSI)2016年判断标准.不同年龄组(新生儿组和非新生儿组)、不同来源分离株耐药率采用WHONET5.6统计分析软件进行分析.结果 共对56 214临床分离株进行监测,其中革兰阳性菌占41.5％(23 328株),革兰阴性菌占58.5％(32 886株),前5位分离株分别是大肠埃希菌7 995株(14.2％)、金黄色葡萄球菌6 468株(11.5％)、肺炎链球菌6 225株(11.1％)、流感嗜血杆菌5 435株(9.7％)、肺炎克雷伯菌4 523株(8.0％).新生儿组肺炎克雷伯菌、阴沟肠细菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌对美罗培南耐药率分别为27.4％(326/1 189)、8.1％ (29/358)、2.0％(27/1 362)、19.5％ (34/174)、49.7％(230/463),非新生儿组分别为15.4％ (512/3 327)、4.8％ (40/841)、2.3％(151/6 564)、13.7％(252/1 840)、53.4％(860/1 611).耐甲氧西林金黄色葡萄球菌(MRSA)在新生儿组和非新生儿组的比例分别为46.2％(649/1 404)、33.3％(1 668/5 010).新生儿和非新生儿组肺炎链球菌(非脑脊液)分离株青霉素不敏感比例分别为17.6％ (6/34)、18.2％(1 121/6 158),流感嗜血杆菌产β-内酰胺酶阳性比例分别为33.8％(47/139)、44.4％(2 345/5 282).结论 我国儿童细菌耐药性特别是新生儿细菌耐药性应引起高度重视.%Objective To analyze the antimicrobial resistance profile in Chinese children.Methods This was a prevalence survey.From January 1 through December 31,2016,the isolates were collected from 10 tertiary children hospitals in China.Antimicrobial susceptibility testing was carried out by routine laboratory methods.The penicillin susceptibility of streptococcus pneumonia and Meropenem susceptibility of gram-negative bacteria were detected by E-test and disk diffusion method respectively.Antimicrobial susceptibility results were interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) Guideline 2016.The data of antimicrobial susceptibility testing of isolates from either the different patients (neonatal group and non-neonatal group) or various sources were analyzed by WHONET 5.6 software.Results A total of 56 241 isolates were collected,of which 41.5％ (23 328 isolates) were gram-positive organisms and 58.5％ (32 886 isolates) gram-negative organisms.The five leading pathogens were Escherichia coli (7 995/56 214,14.2％),Straphylococcus aureus (6 468/56214,11.5％),Streptococcus pneumonia (6 225/56 214,11.1％),Haemophilus influenza (5 435/56 214,9.7％) and Klebsiella pneumonia (4 523/56 214,8.0％).The Meropenem resistance rates of Klebsiella pneumonia,Enterobacter cloacae,Escherichia coil,Pseudomonas aeruginosa,Acinetobacter baumonia isolates were 27.4％ (326/1 189),8.1％ (29/358),2.0％ (27/1 362),19.5％ (34/174),49.7％ (230/463) in neonatal group and 15.4％ (512/3 327),4.8％ (40/841),2.3％ (151/6 564),13.7％ (252/1 840),and 53.4％ (860/1 611) in non-neonatal group.The Methicillin-resistant Staphylococcus aureus (MRSA) rates of neonatal group and non-neonatal group were 46.2％ (649/1 404)and 33.3％ (1 668/5 010).The penicillin non-susceptible rates of Streptococcus pneumonia in the two groups were 17.6％(6/34) and 18.2％(1 121/6 158) respectively.The 3-1actamase positive rates of Haemophilus pneumonia isolates in the neonatal group and non-neonatal groups were 33.8％(47/139) and 44.4％ (2 345/5 282)respectively.Conclusion This investigation highlights the worrisome trend of antimicrobial resistance in children,especially among neonatal patients in China.