2018-2021年重庆儿童医院临床分离菌的分布特征和耐药性分析

Distribution and antibiotic resistance profile of clinical isolates in Chongqing Children's Hospital from 2018 to 2021

目的了解2018—2021年重庆儿童医院临床分离菌的分布特征及耐药性,为临床合理使用抗菌药物和医院感染的预防控制提供科学依据。方法采用纸片扩散法或全自动仪器法对临床分离菌株进行体外药敏试验,按照CLSI 2021年标准判读结果,用WHONET 5.6软件进行数据分析。结果2018—2021年共收集临床分离株57888株,其中革兰阴性菌占62.0%,革兰阳性菌占38.0%。分离病原菌主要来自于下呼吸道标本,各年龄组分离的主要病原菌分布不同,新生儿主要以大肠埃希菌和肺炎克雷伯菌为主,婴幼儿期主要以肺炎链球菌和流感嗜血杆菌为主。新生儿组耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯类鲍曼不动杆菌(CRAB)的检出率(26.8%和11.5%)明显低于其他各组,而耐碳青霉烯类肺炎克雷伯菌(CRKP)和耐碳青霉烯类铜绿假单胞菌(CRPA)的检出率(22.8%和15.6%)则明显高于其他各组;婴儿期耐碳青霉烯类大肠埃希菌(CREC)的检出率最高(7.3%);青春期组鲍曼不动杆菌对抗菌药物的耐药率(>45%)明显高于其他各组。结论儿童各个年龄组之间细菌的分布和对抗菌药物的耐药性有所不同,可以根据儿童年龄进行分组分析,以便更好指导临床合理用药和院感防控。

Objective To understand the distribution and antibiotic resistance profiles of clinical isolates in Chongqing Children's Hospital from 2018 to 2021 for rational use of antibiotics and effective prevention and control of hospital infections.Methods The antimicrobial susceptibility of clinical isolates was carried out by using Kirby-Bauer method or automated systems.The results were analyzed using WHONET 5.6 software and interpreted according to the Clinical and Laboratory Standards Institute breakpoints(2021 Edition).Results A total of 57888 clinical isolates were collected from 2018 to 2021,of which gram negative organisms and gram positive cocci accounted for 62.0%and 38.0%,respectively.The strains were mainly isolated from lower respiratory tract samples.The main pathogens distributed differently among age groups.The top two pathogens were E.coli and K.pneumoniae in neonates,and S.pneumoniae and H.influenzae in infants and toddlers.The prevalence of methicillin-resistant S.aureus(MRSA)and carbapenem-resistant Acinetobacter baumannii was 26.8%and 11.5%neonates,significantly lower than in other age groups.The prevalence of carbapenem-resistant K.pneumoniae and P.aeruginosa(22.8%and 15.6%)was significantly higher than in other age groups.The prevalence of carbapenem-resistant E.coli in infants was the highest(7.3%).The resistance rate of A.baumannii to antibiotics in adolescence(>45%)was significantly higher than in other age groups.Conclusions The distribution and antimicrobial resistance profiles were different among age groups of children.Therefore,the clinical isolates from children should be monitored according to their age to better guide rational antibiotic use and improve the prevention and control of hospital infections.