江西省连续三年儿科患者两种耐碳青霉烯类肠杆菌科细菌的多中心调查

A multicenter investigation of two types of carbapenem-resistant Enterobacteriaceae in pediatric patients in Jiangxi Province for three consecutive years

目的评价江西省儿科患者耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKPN)和耐碳青霉烯类大肠埃希菌(carbapenem-resistant Escherichia coli,CRECO)2种耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)负担。方法回顾性调查2016年1月—2018年12月江西省30家医院儿科(新生儿组和非新生儿组)患者CRKPN及CRECO检出情况,并对不同类型医疗机构的检出情况进行对比分析;同时收集成人患者相应资料并与儿科患者进行对比分析。结果2016年—2018年30家医院儿科患者2种CRE(CRKPN/CRECO)年检出率分别为5.89%、4.03%、4.24%,总体呈下降趋势(χ^(2)趋势=5.568,P=0.018);新生儿组CRKPN/CRECO 3年检出率高于非新生儿组(8.44%vs.3.40%;χ^(2)=63.155,P<0.001)和成人组(8.44%vs.3.45%;χ^(2)=97.633,P<0.001),儿科患者CRKPN 3年检出率高于CRECO(9.10%vs.2.48%;χ^(2)=128.177,P<0.001),妇幼专科医院儿科非新生儿患者CRKPN/CRECO 3年检出率高于综合性医院(4.35%vs.1.36%;χ^(2)=25.930,P<0.001);儿科患者检出CRKPN/CRECO的标本以痰液(31.64%)、血液(24.36%)、尿液(13.82%)、脓液(8.36%)为主。结论虽然儿科患者CRKPN/CRECO检出率整体呈现下降趋势,但新生儿患者检出率仍较高,应加强其监测及预防控制措施。

Objective To evaluate the burden of carbapenem-resistant Klebsiella pneumoniae(CRKPN)and carbapenem-resistant Escherichia coli(CRECO),two types of carbapenem-resistant Enterobacteriaceae(CRE),in pediatric patients in Jiangxi Province.Methods A retrospective investigation was carried out for the distribution of CRKPN/CRECO in pediatric(neonatal group and non-neonatal group)and adult patients in 30 hospitals in Jiangxi Province from January 2016 to December 2018,and the changing trends and detection situations of different patients and types of hospitals were compared and analyzed.Results From 2016 to 2018,the annual resistance rates of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients were 5.89%,4.03%,and 4.24%,respectively,showed a downward trend(χ^(2) trend=5.568,P=0.018).The resistance rate of Klebsiellae pneumoniae and Escherichia coli to carbapenem in neonatal group was higher than that in non-neonatal group(8.44%vs.3.40%;χ^(2)=63.155,P<0.001)and adult group(8.44%vs.3.45%;χ^(2)=97.633,P<0.001).In pediatric patients,the 3-year carbapenem resistance rate of Klebsiella pneumoniae was higher than that of Escherichia coli(9.10%vs.2.48%;χ^(2)=128.177,P<0.001).In non-neonatal pediatric patients,the 3-year resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in maternity and children hospitals was higher than that in general hospitals(4.35%vs.1.36%;χ^(2)=25.930,P<0.001).CRKPN/CRECO detected in pediatrics were mainly isolated from sputum(31.64%),blood(24.36%),urine(13.82%),and pus(8.36%).Conclusion Although the overall resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients showed a downward trend,that in neonatal patients was still high,and the monitoring and prevention and control measures of CRE should be strengthened in neonatal patients.