中国儿童细菌耐药监测组2019年儿童细菌耐药监测

Antimicrobial resistance profile of clinical isolates in pediatric hospitals in China:report from the ISPED Surveillance Program in 2019

背景中国儿童细菌耐药监测组(ISPED)2015年成立后,每年对成员单位的耐药监测数据进行汇总和分析,以此代表中国监测儿童细菌耐药情况。目的对我国儿童细菌感染和耐药现状进行监测汇总,以期指导儿童抗生素合理应用。设计横断面调查,ISPED要求成员单位统一细菌培养、鉴定方法、抗菌药物敏感实验条件和方法,要求以统一格式上报分离到的有效菌株和细菌耐药情况,汇总数据后统计中国大陆儿童细菌感染和耐药现状。方法菌株资料来源于2019年1月1日至12月31日国内11所三级甲等儿童教学医院,细菌抗生素敏感性试验采用自动化仪器法及KB纸片法,肺炎链球菌青霉素药物敏感试验采用E⁃test法,结果判断采用美国临床实验室标准化委员会(CLSI)2019年判断标准。主要结局指标观察儿科菌群分布特征及细菌耐药性变化,重点监测多重耐药菌在儿科群体中的检出情况。结果共对76287临床分离株进行监测,革兰阳性菌和阴性菌分别占41.0%和59.0%。前5位分离株分别是:大肠埃希菌(12.5%)、肺炎链球菌(11.5%)、流感嗜血杆菌(11.5%)、金黄色葡萄球菌(11.2%)和肺炎克雷伯菌(6.9%),其中金黄色葡萄球菌是新生儿人群最主要分离菌,非新生儿人群最主要分离菌是肺炎链球菌。多重耐药菌(MDROs)在儿童中较为普遍,碳青霉烯类耐药的肠杆菌科细菌(CRE)、铜绿假单胞菌(CR⁃PA)和鲍曼不动杆菌(CR⁃AB)检出率分别为8.7%、23.2%和54.0%,其中CRE在新生儿人群检出率高于非新生儿人群(11.7%vs 7.6%),CR⁃PA和CR⁃AB在新生儿人群的比例低于非新生儿人群(19.2%vs 23.3%,30.4%vs 57.7%);甲氧西林耐药金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)检出率分别为35.0%和76.4%。呼吸道是CRE、CR⁃PA、CR⁃AB和MRSA的最主要标本来源。MDROs对临床多种抗生素呈现高水平耐药,其中CR⁃AB对临床监测的多种抗菌药物耐药率均>70%。流感嗜血杆菌β⁃内酰胺酶阳性检出率为63.9%。结论MDROs在儿童患者分离菌株中较为普遍,建立有效的多学科协作机制遏制儿童细菌耐药发生十分必要。

Background Chinese Inspect Survey of Pediatric Consortium(ISPED) Surveillance program was established in 2015. The data of antibiotics resistance were collected from each hospital of ISPED and summarized every year to monitor the bacterial drug resistance among Chinese children. Objective This study is aimed to investigate the antimicrobial resistance profiles of pathogens in Chinese children and guide the reasonable use of antibiotics. Design This is a cross-sectional survey. Every hospital conducted the standard procedure of bacterial culture, identification and antimicrobial susceptibility test. The bacterial information and antibiotics resistance data were collected by lead hospital every year. All data were analyzed to reflect the current bacterial infection and drug resistance among children. Methods Clinical isolates were collected from 11 tertiary children hospitals in China in 2019. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to the criteria of Clinical and Laboratory Standards Institute(CLSI) 2019 breakpoints. Penicillin susceptibility of streptococcus pneumonia was detected by E-test. Main outcome measures Monitor and detect the distribution of bacteria strains in children and the changes of bacteria drug resistance, especially the multi-drug resistant bacteria among pediatric patients. Results A total of 76,287 isolates were collected, of which 41.0% was gram-positive organisms and 59.0% was gram-negative organisms. Top-five pathogens were as follows, Escherichia coli(12.5%), Streptococcus pneumonia(11.5%), Haemophilus influenza(11.5%), Straphylococcus aureus(11.2%), and Klebsiella pneunoniae(6.9%). Straphylococcus aureus and Streptococcus pneumonia was the primary pathogen in neonatal group and non-neonatal group respectively. Multi-drug resistant organisms(MDROs) were very common in children. The detection rate of Carbapenem resistance Enterobacteriaceae(CRE), Pseudomonas aeruginosa(CR-PA) and Acinetobacter baumannⅡ(CR-AB) was 8.7%, 23.2% and 54.0% respectively. CRE was higher in neonatal group(11.7%) than non-neonatal group(7.6%), while CR-PA and CR-AB was lower in neonatal group(19.2% and 30.4%) than non-neonatal group(23.2% and 57.7%). The rates of Methicillin-resistant Staphylococcus aureus(MRSA) and Coagulase negative staphylococci(MRCNS) were 35.0% and 76.4% respectively. Most of MDROs(CRE, CR-PA, CR-AB and MRSA) were seperated from respiratory tract. MDROs presented high-level drug resistances, especially CR-AB presenting >70% resistance to most antibiotics. The β-lactamase positive rate of Haemophilus influenza isolates was 63.9%. Conclusion MDROs were very common in children and it’s necessary to establish an effective Multiple Disciplinary Team(MDT) to control the antimicrobial resistance in pediatric group.