不同地区儿童社区获得性肺炎常见革兰阴性菌对碳青霉烯类药物的耐药性差异及变迁

Differences and changes of drug resistance of common Gram-negative bacteria to carbapenems in children with community-acquired pneumonia in different areas

目的 比较不同地区儿童社区获得性肺炎(community-acquired pneumonia,CAP)的痰液培养中常见革兰阴性菌对碳青霉烯类药物的耐药性差异及变迁,为医疗援助提供参考。方法 回顾性研究2019年6月至2022年6月湖州和安顺地区CAP患儿的痰液培养及药敏结果,分析历年常见革兰阴性菌对碳青霉烯类药物的耐药性,比较不同地区间差异及历年耐药性变迁。结果 近3年两个地区痰液培养常见革兰阴性菌为肺炎克雷伯菌、大肠埃希菌。湖州地区肺炎克雷伯菌检出率在2019、2021年明显高于安顺地区(P<0.05),耐药率2019年明显高于安顺地区(P<0.05),2021年低于安顺地区(P<0.05);湖州地区肺炎克雷伯菌耐药率逐年降低,2021年明显低于2019年(P<0.05),安顺地区逐年升高,2021年明显高于2019年(P<0.05)。对于大肠埃希菌,湖州地区检出率在近3年中均明显低于安顺地区(P<0.05),其耐药率在同一年不同地区以及同一地区近3年的变迁比较,差异无统计学意义(P>0.05)。结论 儿童CAP常见革兰阴性菌对碳青霉烯类药物的耐药性在不同地区具有差异,并逐年变化,在医疗援助中,依据本地区经验的同时,更要根据受援医院的细菌耐药性监测系统,结合当地情况选用抗菌药物。

Objective To compare the differences and changes of drug resistance of common gram-negative bacteria to carbapenems in sputum culture of children with community-acquired pneumonia in different regions,and to provide reference for medical assistance.Methods The results of sputum culture and drug sensitivity of children with CAP in Huzhou and Anshun from June 2019 to June 2022 were retrospectively studied.The drug resistance of common gram-negative bacteria to carbapenems over the years was analyzed,and the regional differences and drug resistance changes over the years were compared.Results Klebsiella pneumoniae and Escherichia coli were the common gram-negative bacteria in sputum culture in two areas in recent three years.The detection rate of Klebsiella pneumoniae in Huzhou was significantly higher than that in Anshun in 2019 and 2021(P<0.05),and the drug resistance rate was significantly higher than that in Anshun in 2019(P<0.05)and lower than that in Anshun in 2021(P<0.05).The drug resistance rate of Klebsiella pneumoniae in Huzhou decreased year by year,which was significantly lower in 2021 than in 2019(P<0.05),and increased year by year in Anshun,which was significantly higher in 2021 than in 2019(P<0.05).For Escherichia coli,the detection rate in Huzhou area was significantly lower than that in Anshun area in recent three years(P<0.05),and there was no significant difference in drug resistance rate between different areas and the same area in the same year(P>0.05).Conclusion The drug resistance of common gram-negative bacteria in children with CAP to carbapenem varies in different regions and changes year by year.In medical assistance,according to the local experience,it is more necessary to select antibiotics according to the bacterial drug resistance monitoring system of the receiving hospital and the local situation.