2019至2020年西安儿童医院儿童细菌感染分布和耐药监测分析

Analysis of bacterial infection and antimicrobial resistance profile of clinical isolates of children in Xi’an Children’s Hospital from 2019 to 2020

目的了解西安儿童医院儿童细菌感染性疾病的病原分布特点和耐药现状,以指导抗菌药物的应用并预防多重耐药菌(MDROs)的产生。方法收集2019年1月至2020年12月西安市儿童医院住院患儿临床分离的菌株,对菌株临床分布特点及耐药性进行分析,并与全国监测数据进行比较。结果共分离出菌株9044株,检出数居前5位依次为凝固酶阴性葡萄球菌(CNS)、大肠埃希菌(Eco)、化脓性链球菌(Spy)、金黄色葡萄球菌(Sau)和嗜麦芽窄食单胞菌(Sma),分别占14.3%(1291/9044)、10.3%(920/9044)、9.6%(870/9044)、9.0%(822/9044)和5.6%(507/9044)。重点耐药菌中耐甲氧西林金黄色葡萄球菌(MRSA)、红霉素耐药肺炎链球菌(ERSP)、碳青霉烯耐药铜绿假单胞菌(CR-Pae)检出率分别为30.1%、92.1%和14.2%,低于全国水平(35.0%、98.8%和23.2%),差异均有统计学意义(χ^(2)=7.89、P=0.01,χ^(2)=75.98、P<0.001,χ^(2)=10.12、P<0.001),而耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和碳青霉烯耐药鲍曼不动杆菌(CR-Aba)检出率分别为81.8%和68.9%,均高于全国水平(76.4%和54.0%),差异均有统计学意义(χ^(2)=4.78、P=0.03,χ^(2)=11.53、P<0.001)。共检出MDROs 920株,检出率为10.2%(920/9044),最常见的依次为Eco[47.4%(436/920)]、Sau[23.7%(218/920)]和Kpn[13.2%(121/920)];主要分离自脓液[46.1%(424/920)]、呼吸道[28.9%(266/920)]和血液[11.1%(102/920)]。分离细菌对多种抗菌药物呈现不同程度的耐药性,部分菌株耐药率与全国监测数据差异较大,其中Sau和CNS对克林霉素耐药率分别为67.8%(564/832)和65.0%(724/1114),显著高于全国监测数据[30.9%(2645/8561)和25.5%(1409/5524)](χ^(2)=458.8、662.7,P均<0.001);Eco对头孢吡肟、亚胺培南和美罗培南耐药率分别为14.4%(135/935),1.7%(16/935)和1.2%(11/935),显著低于全国水平[22.8%(2181/9567),3.2%(306/9567)和4.2%(402/9567)](χ^(2)=34.62、P<0.001,χ^(2)=6.34、P=0.01,χ^(2)=20.64、P<0.001);Aba对头孢他啶、亚胺培南耐药率分别为65.2%(88/135)和62.5%(84/135),显著高于全国水平[53.4%(1621/3036)和51.9%(1576/3036)](χ^(2)=7.23、P=0.01,χ^(2)=5.51、P=0.02);Pae对哌拉西林、头孢他啶、头孢吡肟、美罗培南耐药率分别为8.6%(20/233),7.7%(18/233),2.7%(6/233)和8.7%(20/233),显著低于监测数据[15.2%(508/3344),14.0%(468/3344),10.2%(341/3344)和20.0%(669/3344)],差异有统计学意义(χ^(2)=7.56、P=0.01,χ^(2)=7.29、P=0.01,χ^(2)=14.45、P<0.001,χ^(2)=18.27、P<0.001)。结论本院儿童感染性疾病常见细菌分布及对多种抗菌药物的耐药率如Sau和CNS对克林霉素,Eco对头孢吡肟、碳青霉烯类抗菌药物,Aba对头孢他啶、亚胺培南以及Pae对β-内酰胺类和碳青霉烯类抗菌药物的耐药性与全国监测水平差异较大,需进一步加强对重点耐药菌如MRCNS、CR-Aba的感染防控,针对本地区细菌感染特点合理应用抗菌药物,对于降低感染率和院内感染播散有重要意义。

Objective To investigate the distribution and antimicrobial resistance profiles of bacterial infections among children in Xi’an Children’s Hospital,and to guide the reasonable use of antibiotics and precaution of multi-drug-resistant organisms(MDROs).Methods The clinical culture specimens of hospitalized children in Xi’an Children’s Hospital from January 2019 to December 2020 were isolated,and the distribution and drug resistance were analyzed,retrospectively,which were compared with the national surveillance data.Results Total of 9044 isolates were collected.The top-five pathogens were coagulase negative Staphylococci(CNS),Escherichia coli(Eco),Streptococcus pyogenes(Spy),Staphylococcus aureus(Sau)and Stenotrophomonas maltophilia(Sma),the proportions were 14.3%,10.3%,9.6%,9.0%and 5.6%,respectively.The detection rates of methicillin-resistant Staphylococcus aureus(MRSA),erythromycinresistant Streptococcus pneumoniae(ERSP)and Carbapenem-resistance Pseudomonas aeruginosa(CRPae)were 30.1%,92.1%,and 14.2%,which were significantly lower than the national rates of 35.0%,98.8%and 23.2%(χ^(2)=7.89,P=0.01;χ^(2)=75.98,P<0.001;χ^(2)=10.12,P<0.001);while the rates of methicillinresistant coagulase-negative staphylococci(MRCNS)and carbapenem-resistance Acinetobacter baumann(CR-Aba)were 81.8%and 68.9%,which were higher than the national rates of 76.4%and 54.0%(χ^(2)=4.78,P=0.03;χ^(2)=11.53,P<0.001).The average detection rate of MDROs was 10.2%(920/9044),and the most common strains of MDROs were Eco[47.4%(436/920)],Sau[23.7%(218/920)]and Kpn[13.2%(121/920)].The main sources of MODRs were pus[46.1%(424/920)],respiratory tract[28.9%(266/920)]and blood[11.1%(102/920)].The strains were highly resistant to many kinds of antibiotics,some drug resistance rates were significantly different from the national surveillance levels.The prevalence of resistance of Sau and CNS against clindamycin were 67.8%(564/832)and 65.0%(724/1114),respectively,which were significantly higher than those of the national rates[30.9%(2645/8561)and 25.5%(1409/5524)],with significant differences(χ^(2)=458.8,662.7,both P<0.001);the resistance rates of Eco were as the following:14.4%(135/935)to cefepime,1.7%(16/935)to imipenem,1.2%(11/935)to meropenem,which were significantly lower than those of the national levels[22.8%(2181/9567),3.2%(306/9567)and 4.2%(402/9567)],respectively,with significant differences(χ^(2)=34.62,P<0.001;χ^(2)=6.34,P=0.01;χ^(2)=20.64,P<0.001);resistance rates of Aba to ceftazidime and imipenem were 65.2%(88/135)and 62.5%(84/135),significantly higher than those of national surveillance levels[53.4%(1621/3036)and 51.9%(1576/3036)](χ^(2)=7.23,P=0.01;χ^(2)=5.51,P=0.02);the resistance rates of Pae to piperacillin,ceftazidime,cefepime and meropenem were 8.6%(20/233),7.7%(18/233),2.7%(6/233)and 8.7%(20/233),respectively,significantly lower than those of the national surveillance rates[15.2%(508/3344),14.0%(468/3344),10.2%(341/3344)and 20.0%(669/3344)],with significant differences(χ^(2)=7.56,P=0.01;χ^(2)=7.29,P=0.01;χ^(2)=14.45,P<0.001;χ^(2)=18.27,P<0.001).Conclusions The distribution and rates of antimicrobial resistance profiles of bacterial in our hospital were different from the national level,especially the resistance rates of Sau and CNS to clindamycin,Eco to cefepime and carbapenem antibiotics,Aba to ceftazidime and imipenem,Pae toβ-lactam and carbapenem antibiotics differed significantly from the national surveillance levels.Therefore,the prevention and control of MRCNS and CR-ABA should be strengthened,and antibiotics should be used rationally according to the characteristics of our region to reduce the infection rate and nosocomial infection.