2016—2018年11家儿童医院血流感染革兰阴性菌分布及耐药性分析

Analysis of distribution and drug resistance of Gram-negative bacteria causing bloodstream infections in 11 children’s hospitals from 2016 to 2018

目的分析2016—2018年11家儿童医院血流感染革兰阴性菌的分布及对常用抗菌药物的耐药性。方法根据全国细菌耐药监测网技术要求,对血流感染分离革兰阴性菌进行鉴定和药敏试验,药敏结果按2018年CLSI标准判读。结果 2016—2018年自血标本中共分离病原菌14078株,革兰阴性菌4937株,占35.1%,前5位分离菌依次为大肠埃希菌、嗜麦芽寡养单胞菌、肺炎克雷伯菌、木糖氧化无色杆菌和铜绿假单胞菌。大肠埃希菌对哌拉西林/三唑巴坦、头孢替坦、美罗培南、厄他培南和亚胺培南的耐药率<10%。肺炎克雷伯菌对替加环素、妥布霉素和阿米卡星的耐药率<10%。铜绿假单胞菌和鲍曼不动杆菌对左氧氟沙星、美罗培南和亚胺培南的耐药率分别为12.5%、13.0%、0.4%和40.8%、37.7%和20.0%。结论引起儿童血流感染的革兰阴性菌对常用抗菌药物有不同程度耐药,应高度重视,合理使用抗菌药物。

Objective To analyze the distribution and antibiotic resistance profile of Gram-negative bacteria of blood stream infection in 11 children’s hospitals. Methods According to the technical program of China Antimicrobial Resistance Surveillance System(CARSS), the identification and antimicrobial susceptibility tests of those organisms were conducted and the results were interpreted according to CLSI guideline 2018. Results A total of 14,078 strains were collected from blood samples in these hospitals between 2016 to 2018, of which gram-negative bacteria accounted for 35.1%(4,937/14,078), respectively. The top 5 species were Escherichia coli, Stenotrophomonas maltophilia, Klebsiella pneumoniae, Achromobacter xylosoxidans and Pseudomonas aeruginosa. Less than 10%of the Escherichia coli were resistant to piperacillin-tazobactam, cefotetan, meropenem, ertapenem, and imipenem,respectively. Meanwhile, less than 10% of the Klebsiella pneumoniae were resistant to tigecycline, tobramycin,and amikacin, respectively. 12.5%, 13.0%, 0.4% and 40.8%, 37.7%, 20.0% of the Pseudomonas aeruginosa and Acinetobacter baumannii were resistant to levofloxacin, meropenem, and imipenem, respectively. Conclusion The resistance of Gram-negative bacteria to commonly used antibiotics occurred in various extents in bloodstream infections in children. We should pay great attention to the results of surveillance of bacterial resistance, and use antibiotics rationally.