2015-2021年CHINET儿童患者分离的肠杆菌目细菌耐药性变迁

Changing antibiotic resistance profiles of Enterobacterales strains isolated from children:data from CHINET Antimicrobial Resistance Surveillance Program,2015-2021

目的了解2015-2021年CHINET儿童患者分离的肠杆菌目细菌的分布及耐药性变迁。方法采用纸片扩散法或商品化药敏试验自动测试仪器法按照CHINET技术方案进行药敏试验,并采用CLSI 2021年版标准判断结果。结果2015-2021年共收到儿童患者分离的肠杆菌目细菌81681株,占儿童革兰阴性杆菌的50.1%,其中大肠埃希菌、克雷伯菌属和肠杆菌属是最常见的细菌;菌株主要分离自尿液标本(29.3%)和呼吸道标本(27.7%)。儿童大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌的ESBL检出率分别为48.8%~57.6%、49.3%~66.7%和23.1%~33.8%。儿童碳青霉烯类耐药肠杆菌目细菌的检出率为5.7%~9.5%,呈下降趋势,其中碳青霉烯类耐药克雷伯菌属、碳青霉烯类耐药肠杆菌属和碳青霉烯类耐药大肠埃希菌的检出率分别为14.1%~22.6%、7.1%~15.7%和2.0%~3.4%。肠杆菌目细菌对环丙沙星的耐药率高于左氧氟沙星;对阿米卡星、多黏菌素B和替加环素仍具有较好的敏感性。沙门菌属对氨苄西林耐药率>70%,而对头孢曲松耐药率<30%。结论儿童患者分离的肠杆菌目部分细菌(如大肠埃希菌、肺炎克雷伯菌)对常见抗菌药物耐药率呈下降趋势,但需加强细菌耐药性的持续监测,以预防和控制耐药菌的广泛播散。

Objective To summarize the changing distribution and antimicrobial resistance profiles of Enterobacterales strains isolated from children in CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2021 breakpoints.Results A total of 81681 strains isolated from children were collected from 2015 to 2021,accounting for 50.1%of gram-negative isolates from children.The most frequently isolated species were Escherichia coli,Klebsiella spp.and Enterobacter spp..The main source of the isolates was urine and respiratory tract,accounting for 29.3%and 27.7%,respectively.The prevalence of extended-spectrumβ-lactamase in E.coli,Klebsiella pneumoniae and Proteus mirabilis was 48.8%-57.6%,49.3%-66.7%,and 23.1%-33.8%,respectively.The prevalence of carbapenem-resistant Enterobacterales was 5.7%-9.5%,with a decreasing trend over the 7-year period.The prevalence of carbapenem-resistant Klebsiella spp.,carbapenemresistant Enterobacter spp.,and carbapenem-resistant E.coli was 14.1%-22.6%,7.1%-15.7%,and 2.0%-3.4%,respectively.The Enterobacterales showed higher resistance rates to ciprofloxacin compared to levofloxacin.The Enterobacterales strains were still highly susceptible to amikacin,polymyxin B,and tigecycline.More than 70%of the Salmonella spp.strains were resistant to ampicillin,while lower than 30%of these strains were ressitant to ceftriaxone.Conclusions Some Enterobacterales species isolated from children such as E.coli and K.pneumoniae showed decreasing resistance to commonly used antimicrobial agents.However,continuous monitoring of bacterial resistance should be strengthened in order to prevent and control the spread of drugresistant bacteria.