中国儿童细菌耐药监测组2021年儿童细菌耐药监测

Antimicrobial resistance profile of clinical strains isolated from children in China:A report from the ISPED program in 2021

背景中国儿童细菌耐药监测组(ISPED)每年对成员单位的耐药监测数据进行汇总和分析,以监测中国儿童感染性病原学变迁和耐药情况。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。方法菌株资料来源于2021年1月1日至12月31日国内13所三级甲等儿童教学医院,细菌抗菌药物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性试验采用E-test法,结果判断采用美国临床实验室标准化委员会2021年标准。各成员单位统一细菌培养、鉴定方法、抗菌药物敏感试验条件和方法,每年以统一格式上报分离到的有效菌株和细菌耐药资料,进行数据汇总和统计分析。主要结局指标儿科菌群分布特征及主要病原菌耐药性变化。结果2021年ISPED单位共分离到63508株临床有效菌株,革兰阳性菌和革兰阴性菌的比例分别为39.9%和60.1%。前10位分离株分别是:大肠埃希菌12.7%、肺炎链球菌12.3%、金黄色葡萄球菌11.6%、流感嗜血杆菌11.4%、卡他莫拉菌6.5%、肺炎克雷伯菌5.2%、铜绿假单胞菌4.0%、表皮葡萄球菌3.7%、鲍曼不动杆菌2.4%和化脓性链球菌2.1%。不同年龄组的主要分离菌分布不同,其中金黄色葡萄球菌在新生儿中分离率最高(18.7%),肺炎链球菌是>28 d至5岁儿童主要分离菌(13.6%~20.8%),大肠埃希菌是>5岁儿童最主要分离菌(22.4%)。青霉素不敏感的肺炎链球菌为9.6%。多重耐药菌(MDROs)对临床多种抗生素呈现高水平耐药,碳青霉烯类耐药的肠杆菌目细菌、肺炎克雷伯菌、铜绿假单胞菌(CR-PA)和鲍曼不动杆菌(CR-AB)检出率分别为4.6%、14.8%、6.7%和30.7%,CR-PA在新生儿组检出率较高,CR-AB在非新生儿组检出率较高,CR-PA和CR-AB对多种抗生素耐药率在非新生儿组中均明显高于新生儿组。甲氧西林耐药金黄色葡萄球菌检出率为33.2%。结论2021年MDROs在ISPED中总体检出率较往年降低,对多种抗生素的耐药率也有所降低,应警惕新生儿群体中CR-PA的感染与定植。

Background Chinese Infectious Disease Surveillance of Pediatrics(ISPED)was established in 2015.The data of antibiotics resistance were collected from each hospital and summarized every year to monitor the infectious etiology changes and bacterial drug resistance among Chinese children.Objective This study is aimed to investigate the bacterial infectious and antimicrobial resistance profiles of pathogens in Chinese children and guide the reasonable use of antibiotics.Design A cross-sectional survey.Methods Clinical isolates were collected from 13 tertiary children hospitals in China from January 1st to December 31st in 2021.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Penicillin susceptibility of streptococcus pneumonia was detected by E-test.All of the antimicrobial susceptibility testing results were interpreted according to the criteria of Clinical and Laboratory Standards Institute(CLSI)2021.All members used the standard methods to perform bacterial culture,identification and antimicrobial susceptibility test and reported the isolated effective strains and bacterial resistance data in a structured format every year for data summary and statistical analysis.Main outcome measures Detect the distribution of bacteria strains in children and the changes of bacteria drug resistance.Results A total of 63508 isolates were collected,of which 39.9%was gram-positive organisms and 60.1%was gram-negative organisms.Top ten pathogens were as follows,Escherichia coli(12.7%),Streptococcus pneumonia(12.3%),Straphylococcus aureus(11.6%),Haemophilus influenza(11.4%),Moraxella catarrhalis(6.5%),Klebsiella pneunoniae(5.2%),Pseudomonas aeruginosa(4.0%),Staphylococcus epidermidis(3.7%),Acinetobacter baumannii(2.4%)and Streptococcus pyogenes(2.1%).The distribution of the primary pathogenic bacteria in different age groups was different.Among them,Saureus had the highest isolation rate in neonates(18.7%),and S.pneumoniae was the main pathogenic bacteria in children aged from>28 d to 5 years old,arranging from 13.6%to 20.8%.E.coli was the most common pathogen in children over 5 years old(22.4%).The proportion of penicillin-insensitive S.pneumoniae(PNSP)decreased to 9.6%.Multidrug-resistant bacteria(MDROs)showed high levels of resistance to a variety of clinical antibiotics,and the ratios of carbapenem-resistant Enterobacteriaceae(CRE),K.pneumoniae(CR-KP),P.aeruginosa(CR-PA),A.baumannii(CR-AB)were 4.6%,14.8%,6.7%and 30.7%,respectively.The proportions of CR-PA and CR-AB showed a decreasing trend in the past 6 years.The former had a higher detection rate in the neonatal group,while the latter had a higher detection rate in the non-neonatal group.Moreover,the resistance rates of CR-PA and CR-AB to multiple antibiotics were significantly higher in the non-neonatal group than in the neonatal group.Methicillin-resistant Saureus(MRSA)was relatively stable,with a detection rate of 33.2%in 2021.Conclusion The detection rate of MDROs in 2021 was lower than previous years,and the resistance ratio of MDROs also decreased in pediatric patients.We must pay attention to the infection and colonization of CR-PA in the neonatal population.