欢迎访问《中国循证儿科杂志》官方网站，今天是
English Version
中国循证儿科杂志

中国循证儿科杂志 ›› 2024, Vol. 19 ›› Issue (4): 272-281.DOI: 10.3969/j.issn.1673-5501.2024.04.003

• 论著 • 上一篇    下一篇

中国儿童细菌耐药监测组2023年儿童细菌耐药监测

付盼1a，王传清1a ，俞蕙1b，吴霞1b ，许红梅2a，景春梅2b，邓继岿3a，王红梅3a，华春珍4a，陈英虎4a，陈学军4b，陈益平5a，杨锦红5b，李继安6a，王世富6b，曹清7a，王星7b，邓慧玲8a，蔡慧君8b，郝建华9a，高巍9b，黄园园10 ，项红霞11 ，卓志强12a，黄美恋12b   

  1. 1 复旦大学附属儿科医院上海，201102，a 临床检验中心细菌室，b 感染科；2 重庆医科大学附属重庆儿童医院重庆，400015，a 感染科，b 检验科；3 广东省深圳市儿童医院感染科深圳，518034；4 浙江大学医学院附属儿童医院杭州，310005，a 感染科，b 检验科；5 温州医学院医科大学第二附属医院（育婴儿童医院）温州，325027，a 感染科，b 检验科；6 山东大学附属儿童医院济南，250100，a 感染科，b 检验科；7 上海交通大学医学院附属上海儿童医学中心上海，200127，a 感染科，b 检验科；8 陕西省西安市儿童医院西安，710003，a 感染科，b 检验科；9 河南省开封市儿童医院（东院）开封，475099，a 感染科，b 检验科；10 吉林大学白求恩第一医院儿科吉林，130021；11 江苏省无锡市儿童医院感染科无锡，214023；12 福建省厦门市儿童医院厦门，361006，a 感染科，b 检验科


  • 收稿日期:2024-09-05 修回日期:2024-09-23 出版日期:2024-08-25 发布日期:2024-10-31
  • 通讯作者: 王传清，俞蕙

Antimicrobial resistance profile of clinical strains isolated from children in China: A report from the ISPED program 2023

FU Pan1a, WANG Chuanqing1a, YU Hui1b, WU Xia1b, XU Hongmei2a, JING Chunmei2b, DENG Jikui3a, WANG Hongmei3a, HUA Chunzhen4a, CHEN Yinghu4a, CHEN Xuejun4b, CHEN Yiping5a, YANG Jinhong5b, LIN Ji'an6a, WANG Shifu6b, CAO Qing7a, WANG Xing7b, DENG Huiling8a, CAI Huijun8b, HAO Jianhua9a, GAO Wei9b, HUANG Yuanyuan10, XIANG Hongxia11, ZHUO Zhiqiang12a, HUANG Meilian12b   

  1. 1 Children's Hospital of Fudan University, Shanghai 201102, China, a. Clinical Microbiology Department, b. Infectious Disease Department; 2 Children's Hospital of Chonqing Medical University, Chongqing 400015, China, a. Infectious Disease Department, b. Department of Medical Laboratory; 3 Infectious Disease Department, Shenzhen Children's Hospital, Shenzhen 518034, China; 4 The Children's Hospital Zhejiang University School of Medicine, Hangzhou 310005, China, a. Infectious Disease Department, b. Department of Medical Laboratory; 5 The second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China, a. Infectious Disease Department, b. Department of Medical Laboratory; 6 Children's Hospital Affiliated to Shandong University, Jinan 250100, China, a. Infectious Disease Department, b. Department of Medical Laboratory; 7 Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China, a. Infectious Disease Department, b. Department of Medical Laboratory; 8 Xi'an Children's Hospital, Xi'an 710003, China, a. Infectious Disease Department, b. Department of Medical Laboratory; 9 Children's Hospital of Kaifeng City, Kaifeng 475099, China, a. Infectious Disease Department, b. Department of Medical Laboratory; 10 Pediatric Department, The First Bethune Hospital of Jilin University, Changchun 130021, China; 11 Infectious Disease Department, Children's Hospital of Wuxi City, Wuxi 214023, China; 12 Children's Hospital of Xiamen City, Xiamen 361006, China, a. Infectious Disease Department, b. Department of Medical Laboratory

  • Received:2024-09-05 Revised:2024-09-23 Online:2024-08-25 Published:2024-10-31
  • About author:WANG Chuanqing, email: chuanqing523@163.com；YU Hui, email: yuhui4756@sina.com

PDF

466

摘要： 背景：中国儿童细菌耐药监测组（ISPED）每年对成员单位的耐药监测数据汇总和分析，以了解儿童感染性病原学变化和耐药现状。 目的：分析2023年我国儿童细菌感染和耐药现状，旨在指导儿童抗菌药物合理应用。 设计：横断面调查。 方法：菌株资料来源于2023年1月1日至12月31日ISPED成员单位细菌室，细菌抗菌药物敏感性试验采用自动化仪器法及KB纸片法，肺炎链球菌青霉素药物敏感性试验采用Etest法，结果判断采用美国临床实验室标准化委员会（CLSI）2022年标准。 主要结局指标：儿科菌群分布特征及主要分离株对抗菌药物耐药性变化，多重耐药菌（MDROs）在儿科群体中的检出情况。 结果：2023年ISPED单位共分离到58 335株临床有效菌株，革兰阳性菌和阴性菌分别占40%和60%。前5位分离株分别是：大肠埃希菌（14.5%）、肺炎链球菌（12.4%）、金黄色葡萄球菌（11.8%）、流感嗜血杆菌（10.2%）和卡他莫拉菌（6.4%）。新生儿组和非新生儿组最主要分离株分别为金黄色葡萄球菌（17%）和大肠埃希菌（14.4%）。下呼吸道是最主要的标本来源（47.1%），最主要分离株为肺炎链球菌（24.3%）和流感嗜血杆菌（19.4%）。流感嗜血杆菌和卡他莫拉菌产β内酰胺酶的比例较高，分别为74.7%和98.6%。肺炎链球菌和化脓性链球菌对红霉素和克林霉素高度耐药。脑脊液来源和非脑脊液来源的青霉素不敏感肺炎链球菌的检出率分别为93.2%和9%。甲氧西林耐药金黄色葡萄球菌（MRSA）和凝固酶阴性葡萄球菌（MRCNS）的检出率分别为31.2%和77.2%。碳青霉烯类耐药的肠杆菌目细菌（CRE）、铜绿假单胞菌（CRPA）和鲍曼不动杆菌（CRAB）检出率分别为3.7%、8.1%和30.8%。新生儿组CRPA的检出率高于非新生儿组（19.7% vs 7.4%，P<0.01），而CRAB检出率低于非新生儿组（23.2% vs 32.1%，P<0.05）。新生儿组CRAB对多种抗生素如头孢哌酮/舒巴坦、阿米卡星和左氧氟沙星的耐药率均高于非新生儿组（P<0.05）。ICU中MRSA、CRE、CRPA和CRAB的检出率均高于其他科室（P<0.001），尤其是CRAB比例高达62.9%，高于血液科（23.5%，P<0.01）和其他科室（28.1%，P<0.001）；此外，血液科患儿CRE的比例为12.8%，高于其他科室（3.5%，P<0.001）。 结论：2023年，中国儿童CRE和MRSA检出率较往年有所下降；CRAB和CRPA总体检出率较前2年有所升高，其中新生儿组CRPA检出率较高，非新生儿组CRAB的检出率较高。应重点加强ICU和血液科MDROs的主动筛查和持续监测。

关键词: 细菌, 耐药, 儿童, 2023

Abstract: Background：The Chinese Infectious Disease Surveillance of Pediatrics （ISPED） program collects and analyzes the monitoring data of antibiotics resistance from its member units annually to understand changes in pediatric infectious pathogens and resistance patterns in China. Objective：To explore the status of bacterial infections and resistance in children in China for 2023, aiming to guide the rational use of antimicrobial agents in pediatrics. Design：Crosssectional survey. Methods：Clinical isolates were collected from children hospitals in China enrolled in the ISPED program from January 1st to December 31st, 2023. Antimicrobial susceptibility testing was carried out using a unified protocol using the KirbyBauer method or automated systems. Penicillin susceptibility of streptococcus pneumonia was detected by Etest, with results evaluated according to the 2022 standards of the Clinical and Laboratory Standards Institute (CLSI). Main outcome measures：The distribution characteristics of bacteria strains in children, changes in antimicrobial resistance of major isolated strains, and the detection of multidrugresistant organisms (MDROs) in the pediatric population. Results：A total of 58,335 isolates were collected, of which 40% were grampositive organisms and 60% were gramnegative. The top five pathogens were as follows, Escherichia coli (14.5%), Streptococcus pneumonia (12.4%), Staphylococcus aureus (11.8%), Haemophilus influenza (10.2%), and Moraxella catarrhalis (6.4%). The most common pathogens in neonates and nonneonates were S. aureus (17%) and E. coli (14.4%), respectively. The primary specimen was the lower respiratory tract (47.1%), and the most common pathogens were S. pneumonia (24.3%) and H. influenza (19.4%). The rates of βlactamase production in Haemophilus influenzae and Moraxella catarrhalis were high, at 74.7% and 98.6%, respectively. Both S. pneumoniae and S. pyogenes showed highresistance to erythromycin and clindamycin. The proportion of penicillininsensitive S. pneumoniae (PNSP) from cerebrospinal fluid and noncerebrospinal fluid was 93.2% and 9%, respectively. Methicillinresistant S. aureus (MRSA) and Coagulasenegative staphylococci (MRCNS) accounted for 31.2% and 77.2%, respectively. The carbapenemresistant Enterobacteriaceae (CRE), carbapenemresistant P. aeruginosa (CRPA), carbapenemresistant A. baumannii (CRAB) were 3.7%, 8.1% and 30.8%, respectively. The detection rate of CRPA in the neonatal group was higher than that in the nonneonatal group (19.7% vs 7.4%, P<0.01), whereas the detection rate of CRAB was lower than that in the nonneonatal group (23.2% vs 32.1%, P<0.05). CRAB isolated from neonates presented higher resistance to multiple antimicrobials than nonneonates（P<0.05）. The detection rates of MRSA, CRE, CRPA and CRAB in the ICU department were much higher than those in other departments (P<0.001), especially CRAB, which was as high as 62.9%, much higher than that in the hematology department (23.5%, P<0.01) and other departments (28.1%, P<0.001). In addition, the proportion of CRE in hematology patients was 12.8%, higher than the 3.5% in other departments (P<0.001). Conclusion：In 2023, the detection rates of CRE and MRSA in Chinese children showed a decrease compared to previous years, while the overall detection rates of CRAB and CRPA increased compared to the previous two years, with a notably higher detection rate of CRPA in the neonatal group and CRAB in the nonneonatal group. Proactive screening and continuous monitoring of MDROs in the ICU and hematology departments should be strengthened.

Key words: Bacteria, Antimicrobial resistance, Children, 2023