2014—2017年四川省儿童患者细菌耐药监测数据分析

Surveillance of bacteria resistance in children across Sichuan province from 2014 to 2017

目的对2014—2017年四川省儿童患者(≤14岁)的主要病原菌及耐药性进行分析,为临床抗生素的合理使用提供依据。方法2014—2017年四川省耐药监测网成员单位对儿童临床分离的病原菌进行鉴定,采用纸片扩散法或自动细菌鉴定系统测定细菌的耐药性,所有上报数据经WHONET5.6软件进行汇总、处理和分析。结果2014—2017年,四川省儿童组革兰阳性菌分离率占前3位的分别为金黄色葡萄球菌、肺炎链球菌、凝固酶阴性葡萄球菌。革兰阴性菌中占前3位的细菌分别是大肠埃希菌、流感嗜血菌和肺炎克雷伯菌。分离的病原菌主要来自痰液,占70.6%~74.3%。耐甲氧西林金黄色葡萄球菌从21.5%上升到24.8%。耐甲氧西林凝固酶阴性的葡萄球菌先升后降,2014年为69.4%,2015至2017年从81.7%降至78.2%,未检出对耐万古霉素、利奈唑胺的葡萄球菌属菌株。对耐万古霉素的粪肠球菌从0.9%降至0。非脑脊液分离的耐青霉素的肺炎链球菌检出率范围为1.1%~3.2%。耐亚胺培南铜绿假单胞菌近3年呈下降趋势,从10.2%降至6.6%,略高于2014年6.1%;耐亚胺培南鲍曼不动杆菌的检出率从46.1%降至14.7%。耐亚胺培南大肠埃希菌和肺炎克雷伯菌的检出率分别从0.4%升至1.1%,1.5%升至7.7%。头孢噻肟耐药大肠埃希菌从47.9%降至39.9%。耐氨苄西林流感嗜血菌从40.9%上升至69.4%。结论近4年来,对耐亚胺培南的大肠埃希菌和肺炎克雷伯菌,耐甲氧西林金黄色葡萄球菌及耐氨苄西林流感嗜血菌都呈上升趋势,应加强临床抗生素合理应用的管理,减少或延缓耐药株的出现。

Objective To analyze the distribution and antibiotic resistance of common pathogens isolated from children(patients under 14 years)in Sichuan provincial from 2014 to 2017,and to provide the basis for the rational use of antibiotics.Methods The bacterial isolates from patients in member hospitals of Sichuan Provincial Antimicrobial Resistant Investigation Net were identified.Antimicrobial susceptibility testing was carried out by using the K-B method or automatic microbiological examine systems.The results were analyzed by using WHONET 5.6 software.Results The top three isolates of Gram-positive bacteria were Staphylococcus aureus,Streptococcus pneumoniae and coagulase negative staphylococci.The top three isolates of Gram-negative bacteria were Escherichia coli,Haemophilus influenza and Klebsiella pneumoniae.The main isolates were from sputum with the proportion of 70.6%~74.3%.The prevalence of methicillin-resistant Staphylococcus aureus increased from 21.5%to 24.8%.The prevalence of methicillin-resistant coagulase negative Staphylococcus first rose then descended from 81.7%to 78.2%from 2015 to 2017,but it was 69.4%in 2014.Neither vancomycin resistant strains nor linezolid resistant strains were found in Staphylococcus.The prevalence of vancomycin-resistant Enterococcus faecalis decreased from 0.9%to 0.The rate of penicillin-resistant Streptococcus pneumoniae derived from non-cerebrospinal fluid was between 1.1%and 3.2%.The prevalence of imipenem-resistant Pseudomonas aeruginosa decreased from 10.2%to 6.6%from 2015 to 2017,but was still higher than that of 2014(6.6%).The prevalence of imipenem-resistant Acinetobacter baumannii decreased from 46.1%to 14.7%.The prevalence of imipenem-resistant Escherichia coli and Klebsiella pneumoniae increased from 0.4%to 1.1%and 1.5%to 7.7%,respectively.The prevalence of cefotaxime-resistant Escherichia coli decreased from 47.9%to 39.9%.The prevalence of ampicillin-resistant Haemophilus influenza increased from 40.9%to 69.4%.Conclusion The prevalence of methicillin-resistant Staphylococcus aureus,ampicillin-resistant Haemophilus influenza,imipenem-resistant Escherichia coli,and Klebsiella pneumoniae maintained an upward during the four years,which reminded us to further strengthen the management of antibiotics rational application for reducing or delaying the emerging of resistant strains.