2016至2020年儿童重症监护病房细菌感染及耐药监测的特点和变迁

The characteristics and changes of bacterial infection and drug resistance in pediatric intensive care unit from 2016 to 2020

目的了解复旦大学附属儿科医院儿童重症监护病房(PICU)2016至2020年儿童细菌感染及耐药监测的特点、变迁情况。方法菌株来源于2016年1月1日至2020年12月31日复旦大学附属儿科医院PICU。细菌抗生素敏感性试验按照CHINET统一监测方案进行,采用自动化仪器法或KB纸片扩散法,结果判读按照2020年美国临床实验室标准化委员会(CLSI)标准判读。结果 (1)菌株分布:2016至2020年本中心共监测细菌2 551株,分布前3位均为革兰阴性菌,其中洋葱霍尔德菌呈现曲折下降趋势(13.45%降至1.18%),而肺炎克雷伯菌呈现上升趋势(6.05%升至10.61%)。感染部位以呼吸系统最常见,但分布菌株数量逐年递减,血液系统分布菌株数量逐年递增。呼吸系统感染以鲍曼不动杆菌;血液系统感染2016及2017年最常见细菌为表皮葡萄球菌,2018至2020年为木糖氧化无色杆菌最为常见;泌尿系统感染最常见细菌为屎肠球菌。(2)耐药情况:鲍曼不动杆菌对阿米卡星、庆大霉素、头孢吡肟、头孢他啶具有较高耐药率,历年变化不明显,对头孢哌酮舒巴坦耐药率逐步降低,对亚胺培南及美罗培南耐药率呈现曲折上升趋势。鲍曼不动杆菌及铜绿假单胞菌对左氧氟沙星的耐药率一直处于较低水平,在2020年均出现了高耐药率。大肠埃希菌及肺炎克雷伯菌对于β-内酰胺类抗生素仍有较高的耐药率,两者对左氧氟沙星的耐药率呈下降趋势。大肠埃希菌及肺炎克雷伯菌对亚胺培南耐药率呈下降趋势,对美罗培南耐药率呈上升趋势。屎肠球菌对左氧氟沙星的耐药率呈下降趋势,对多肽类抗生素一直具有较高敏感率。表皮葡萄球菌及金黄色葡萄球菌对四环素类抗生素目前均无耐药性,对氨基糖苷类抗生素,如庆大霉素的耐药率不断下降。结论 PICU细菌感染分布上呈现呼吸道感染、革兰阴性菌感染为主的特点。碳青霉烯耐药肠杆菌、肠球菌以及葡萄球菌的耐药问题日趋严重。

Objective To investigate the characteristics and changes of bacterial infection and drug resistance in PICU at Children′s Hospital of Fudan University from 2016 to 2020.Methods All the strains were collected at Children′s Hospital of Fudan University from January 1st,2016 to December 31st,2020.Antimicrobial susceptibility test was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2020 breakpoints.Results(1)Bacterial distribution:2551 bacteria were monitored from 2016 to 2020 in our center.The top 3 bacteria were all gram-negative bacteria.Among them,Burkholderia cepacian showed a tortuous downward trend(13.45%to 1.18%),and Klebsiella pneumoniae showed an upward trend(6.05%to 10.61%).The most common infected site was respiratory tract,although the strains in the respiratory tract decreased year by year.Baumanii was the most common bacteria in respiratory infections.Staphylococcus epidermidis was the most common bacteria from 2016 to 2017 in blood infections,but Achromobacter xylosoxidans were became the most common bacteria from 2018 to 2020.Enterococcus faecium was the most common bacteria in urinary infections.(2)Drug resistance:Baumanii had a high drug resistance rate to amikacin,gentamicin,cefepime,and cefitadine,with no obvious changes over the years,which had a gradually decreasing drus resistance rate to cefoperazone sulbactam,showing a tortuous upward trend to imipenem and meropenem.Baumanii and Pseudomonas aeruginosa had a low drug resistance to levofloxacin over the years,but with high resistance rates in 2020.Escherichia coliand and Klebsiella pneumoniae still had high resistance rates to beta-lactam antibiotics,and their resistance rates to levofloxacin were decreasing.Escherichia coli and Klebsiella pneumoniae showed decreasing resistance rates to imipenem and increased resistance rates to meropenem.The resistance rate of Enterococcus faecium to levofloxacin decreased and always showed a high susceptibility rate to polypeptide antibiotics.Neither Staphylococcus epidermidis nor Staphylococcus aureus were currently resistant to tetracycline antibiotics,and the resistance rates of aminoglycoside antibiotics,such as gentamicin,was also declining.Conclusion The bacterial infection in PICU shows as the main characteristics of respiratory infection and gram-negative bacteria infection.Carbapenem-resistant Enterobacteriaceae bacteria,Enterococci and Staphylococcus species are becoming increasingly more resistant.