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Chinese Journal of Evidence-Based Pediatrics ›› 2021, Vol. 16 ›› Issue (1): 43-50.DOI: 10.3969/j.issn.1673-5501.2021.01.002

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Antimicrobial resistance profile of clinical isolates in pediatric hospitals in China: report from the ISPED Surveillance Program in 2019

FU Pan1a,c, HE Leiyan1a,c, WANG Chuanqing1a, YU Hui1b, XU Hongmei2a, JING Chunmei2b, DENG Jikui3a, ZHAO Ruizhen3b, HUA Chunzhen4a, CHEN Yinghu4a, CHEN Xuejun4b, ZHANG Ting5a, ZHANG Hong5b, CHEN Yiping6a, YANG Jinhong6b, LIN Aiwei7a, WANG Shifu7b, CAO Qing8a, WANG Xing8b, DENG Huiling9a, CAO Sancheng9b, HAO Jianhua10a, GAO Wei10b, HUANG Yuanyuan11   

  1. 1 Children's Hospital of Fudan University, Shanghai 201102, China: a Microbiology Department of Clinical Medical Laboratory, b Infectious Disease Department;
    2 Children's Hospital of Chongqing Medical University, Chongqing 400014, China: a Infectious Disease Department, b Department of Medical Laboratory;
    3 Shenzhen Children's Hospital, Shenzhen 518038, China: a Infectious Disease Department, b Department of Medical Laboratory;
    4 The Children's Hospital Zhejiang University School of Medicine Hangzhou 310003, China: a Infectious Disease Department, b Department of Medical Laboratory;
    5 Children's Hospital of Shanghai Jiaotong University Shanghai 200040, China: a Digestive and Infectious Disease Department, b Department of Medical Laboratory;
    6 Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China: a Infectious Disease Department, b Department of Medical Laboratory;
    7 Qilu Children's Hospital of Shandong University, Jinan 250022, China: a Infectious Disease Department, b Department of Medical Laboratory;
    8 Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China: a Infectious Disease Department, b Department of Medical Laboratory;
    9 Xi'an Children's Hospital, Xi'an 710043, China: a Infectious Disease Department, b Department of Medical Laboratory;
    10 Children's Hospital of Kaifeng City, Kaifeng 475099, China: a Infectious Disease Department, b Department of Medical Laboratory;
    11 The First Hospital Affiliated to Jilin University, Changchun 130021, China: Pediatric Department; c Co-first authors
  • Received:2021-01-14 Revised:2021-01-25 Online:2021-02-25 Published:2021-03-22
  • Contact: WANG Chuanqing,email:chuanqing523@163.com,YU Hui,email:yuhui4756@sina.com

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Abstract: Background Chinese Inspect Survey of Pediatric Consortium(ISPED) Surveillance program was established in 2015. The data of antibiotics resistance were collected from each hospital of ISPED and summarized every year to monitor the bacterial drug resistance among Chinese children. Objective This study is aimed to investigate the antimicrobial resistance profiles of pathogens in Chinese children and guide the reasonable use of antibiotics. Design This is a cross-sectional survey. Every hospital conducted the standard procedure of bacterial culture, identification and antimicrobial susceptibility test. The bacterial information and antibiotics resistance data were collected by lead hospital every year. All data were analyzed to reflect the current bacterial infection and drug resistance among children. Methods Clinical isolates were collected from 11 tertiary children hospitals in China in 2019. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) 2019 breakpoints. Penicillin susceptibility of streptococcus pneumonia was detected by E-test. Main outcome measures Monitor and detect the distribution of bacteria strains in children and the changes of bacteria drug resistance, especially the multi-drug resistant bacteria among pediatric patients. Results A total of 76,287 isolates were collected, of which 41.0% was gram-positive organisms and 59.0% was gram-negative organisms. Top-five pathogens were as follows, Escherichia coli (12.5%), Streptococcus pneumonia (11.5%), Haemophilus influenza (11.5%), Straphylococcus aureus (11.2%), and Klebsiella pneunoniae (6.9%). Straphylococcus aureus and Streptococcus pneumonia was the primary pathogen in neonatal group and non-neonatal group respectively. Multi-drug resistant organisms (MDROs) were very common in children. The detection rate of Carbapenem resistance Enterobacteriaceae (CRE), Pseudomonas aeruginosa (CR-PA) and Acinetobacter baumannⅡ (CR-AB) was 8.7%, 23.2% and 54.0% respectively. CRE was higher in neonatal group (11.7%) than non-neonatal group (7.6%), while CR-PA and CR-AB was lower in neonatal group (19.2% and 30.4%) than non-neonatal group (23.2% and 57.7%). The rates of Methicillin-resistant Staphylococcus aureus (MRSA) and Coagulase negative staphylococci (MRCNS) were 35.0% and 76.4% respectively. Most of MDROs (CRE, CR-PA, CR-AB and MRSA) were seperated from respiratory tract. MDROs presented high-level drug resistances, especially CR-AB presenting >70% resistance to most antibiotics. The β-lactamase positive rate of Haemophilus influenza isolates was 63.9%. Conclusion MDROs were very common in children and it's necessary to establish an effective Multiple Disciplinary Team (MDT) to control the antimicrobial resistance in pediatric group.

Key words: Bacteria, Antimicrobial resistance, Children, Inspect Survey of Pediatrics, 2019