摘要
目的了解全国细菌耐药监测网(CARSS)数据中0~14岁患儿临床常见病原菌的分布及耐药性变迁。方法本研究为描述性研究,从2018年10月至2022年9月CARSS监测报告中提取0~14岁患儿2575040株细菌耐药监测数据,分析耐药数据变迁,并与同时期全年耐药监测结果进行比较。结果2018至2022年,0~14岁患儿检出细菌总数为415306~588016株,占同时期全年监测细菌总数的比例分别为15.9%(514193/3234372)、16.2%(572107/3528471)、12.8%(415306/3249123)、13.0%(485418/3743027)和12.2%(588016/4828509)。其中,革兰阳性球菌所占细菌总数比例分别为45.4%(233456/514193)、44.5%(254869/572107)、44.7%(185756/415306)、42.6%(206903/485418)和41.7%(245044/588016)。革兰阳性菌种分离率前5位为金黄色葡萄球菌(36.0%~38.8%)、肺炎链球菌(27.1%~31.7%)、表皮葡萄球菌(7.3%~9.3%)、屎肠球菌(4.0%~4.8%)和粪肠球菌(2.5%~3.6%);革兰阴性菌分离率前5位为大肠埃希菌(21.8%~26.2%)、流感嗜血杆菌(14.4%~26.4%)、肺炎克雷伯菌(10.1%~14.7%)、卡他莫拉菌(7.3%~11.9%)和铜绿假单胞菌(5.5%~6.8%)。0~14岁患儿细菌主要来源于痰液标本(48.8%~57.0%)。甲氧西林耐药金黄色葡萄球菌检出率为28.7%~30.1%,万古霉素耐药粪肠球菌或屎肠球菌检出率为0.1%~0.3%,儿童非脑脊液分离青霉素耐药肺炎链球菌检出率为0.7%~1.6%,头孢噻肟和(或)头孢曲松耐药的大肠埃希菌和肺炎克雷伯菌检出率分别为43.7%~50.0%和31.8%~42.7%。大肠埃希菌对亚胺培南和美罗培南的耐药率分别为1.2%~1.9%和1.2%~2.0%;肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为7.3%~10.1%和8.2%~12.2%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为6.6%~10.2%和5.3%~9.6%,鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为17.2%~24.0%和19.0%~29.4%。结论2018至2022年,0~14岁患儿临床常见病原菌菌种构成无明显变化,甲氧西林耐药金黄色葡萄球菌、碳青霉烯类耐药肠杆菌目细菌检出率有所下降,但儿童耐药情况仍不容忽视,需长期加强监测。
Objective To understand the distribution and antimicrobial resistance of common bacteria from children aged 0-14 years from China Antimicrobial Resistance Surveillance System.Methods Bacterial resistance data of 2575040 strains from children aged 0-14 years were extracted from the national bacterial resistance surveillance reports from October 2018 to September 2022 and resistance changes were further analyzed by comparing with all data in each year.Results The total number of bacteria isolated from children in 2018-2022 ranged from 415306-588016 strains,accounted for 15.9%(514193/3234372),16.2%(572107/3528471),12.8%(415306/3249123),13.0%(485418/3743027),and 12.2%(588016/4828509),respectively.The proportions of gram-positive bacteria among children were 45.4%(233456/514193),44.5%(254869/572107),44.7%(185756/415306),42.6%(206903/485418),and 41.7%(245044/588016),respectively.The top five isolates of gram-positive bacteria were Staphylococcus aureus(36.0%-38.8%),Streptococcus pneumoniae(27.1%-31.7%),Staphylococcus epidermidis(7.3%-9.3%),Enterococcus faecium(4.0%-4.8%),and Enterococcus faecium(2.5%-3.6%),and the top five isolates of gram-negative bacteria were Escherichia coli(21.8%-26.2%),Haemophilus influenzae(14.4%-26.4%),Klebsiella pneumoniae(10.1%-14.7%),Moraxella catarrhalis(7.3%-11.9%),and Pseudomonas aeruginosa(5.5%-6.8%).The bacteria from children aged 0-14 years commonly isolated from sputum samples(48.8%-57.0%).The prevalence of methicillin-resistant S.aureus was 28.7%-30.1%.The detection rates of vancomycin-resistant E.faecalis or E.faecium were 0.1%-0.3%.The proportions of non-cerebrospinal fluid-derived penicillin-resistant S.pneumoniae were 0.7%-1.6%.The prevalence of cefotaxime and(or)ceftriaxone-resistant E.coli and K.pneumoniae decreased were 43.7%-50.0%and 31.8%-42.7%,respectively.The resistant rates of E.coli to imipenem and meropenem were 1.2%-1.9%and 1.2%-2.0%,respectively,and the resistant rates of K.pneumoniae to imipenem and meropenem were 7.3%-10.1%and 8.2%-12.2%,respectively.About 6.6%-10.2%and 5.3%-9.6%of the P.aeruginosa isolates showed resistant to imipenem and meropenem,respectively,while 17.2%-24.0%and 19.0%-29.4%of the Acinetobacter baumannii isolates were resistant to imipenem and meropenem,respectively.Conclusions There is no significant change in the composition of common clinical pathogens in children aged 0-14 years from 2018 to 2022.The prevalence of some resistant bacteria such as methicillin-resistant S.aureus and carbapenem-resistant Enterobacterales is decreasing.However,it is necessary to pay attention to antimicrobial resistance of bacteria from children and long-term monitoring of the prevalence of resistant bacteria should be conducted.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2023年第11期1001-1010,共10页
Chinese Journal of Pediatrics
关键词
儿童
细菌
抗生素
Child
Bacteria
Antibiotics
