2017年郑州大学附属儿童医院细菌耐药性监测
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摘要
目的了解郑州大学附属儿童医院临床分离菌株分布及对常用抗菌药物的敏感性。方法采用纸片扩散法或自动化仪器法按统一方案进行细菌药物敏感性试验,按CLSI 2017年标准判断结果。结果共分离临床菌株7619株,其中革兰阳性菌2962株(38.9%),革兰阴性菌4657株(61.1%)。前5位分离菌株依次为:流感嗜血杆菌(20.4%)、肺炎链球菌(15.4%)、金黄色葡萄球菌(9.8%)、大肠埃希菌(9.5%)、克雷伯菌属(9.2%)。分离细菌标本来源主要分布:呼吸道(60.8%)、眼分泌物(16.1%)、血液(6.6%)、脓液及创面分泌物(6.1%)、尿液(2.8%)等。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株的检出率分别为36.0%和72.2%。肠球菌属中检出耐万古霉素的粪肠球菌和屎肠球菌各1株。肺炎链球菌中青霉素中介菌株和青霉素耐药菌株的检出率分别为0.8%和0.3%,对红霉素、克林霉素、四环素、甲氧苄啶-磺胺甲唑耐药率较高。肠杆菌科细菌中大肠埃希菌、肺炎克雷伯菌中产ESBL菌株的检出率分别为各自菌种的72.1%、75.6%。2017年共检出碳青霉烯类耐药肠杆菌科细菌(CRE) 263株,碳青霉烯类耐药鲍曼不动杆菌219株、碳青霉烯类耐药铜绿假单胞菌45株。1556株流感嗜血杆菌β内酰胺酶阳性率40.4%,对氨苄西林、甲氧苄啶-磺胺甲唑耐药率分别达到63.3%、88.9%。结论儿童细菌耐药情况呈上升趋势,CRE等多重耐药菌株检出率近年来上升较快,急需加强耐药性监测和抗生素合理应用工作。
Objective To investigate the susceptibility and resistance profile of clinical isolates in Children's Hospital Affiliated to Zhengzhou University. Methods Antimicrobial susceptibility testing was carried out according to a unified protocol ussing KirbyBauer memod or automated systems. Results were analyzed according to CLSI 2017 breakpomts. Results A total of 7 619 clinical isolates were collected from January to December 2017, of which gram positive organisms and gram negative bacilli accounted for38.9%(2 962/7 619) and 61.1%(4 657/7 619), respectively. The top 5 species were H. influenzae(20.4%), S. pneumoniae(15.4%), S.aureus(9.8%), E. coli(9.5%), and Klebsiella spp.(9.2%). The main sources of specimens were respiratory tract(60.8%), eye discharge(16.1%), blood(6.6%), abscess(6.1%), and urine(2.8%). The prevalence of methicillin-resistant strains was 36.0% in S. aureus and 72.2% in coagulase-negative Staphylococcus. Vancomycin-resistant Enterococcus was identified in one strain of E. faecalis and one strains of E. faecium. The prevalence of PISP and PRSP was 0.8% and 0.3%, respectively. S. pneumoniae isolates showed high resistance rate to erythromycin, clindamycin, tetracycline, and trimethoprim-sulfamethoxazole. The prevalence of ESBLs-producing strains was 72.1% in E. coli and 75.6% in K. pneumoniae. A total of 263 carbapenem-resistant Enterobacteriaceae(CRE) strains were identified in 2017, including 219 carbapenem-resistant A.baumannii strains and 45 carbapenem-resistant P. aeruginosa strains. About 40.4% of the 1 556 H. influenzae strains were positive for β-lactamase. Overall, 63.3% and 88.9% of these H.influenzae strains were resistant to ampicillin and trimethoprimsulfamethoxazole, respectively. Conclusions Antimicrobial resistance is on the rise in the bacterial pathogens isolated from children. The prevalence of multidrug resistant strains such as CRE increased rapidly in recent years. Antimicrobial resistance monitoring and rational antibiotic use should be further strengthened.
Objective To investigate the susceptibility and resistance profile of clinical isolates in Children's Hospital Affiliated to Zhengzhou University. Methods Antimicrobial susceptibility testing was carried out according to a unified protocol ussing KirbyBauer memod or automated systems. Results were analyzed according to CLSI 2017 breakpomts. Results A total of 7 619 clinical isolates were collected from January to December 2017, of which gram positive organisms and gram negative bacilli accounted for38.9%(2 962/7 619) and 61.1%(4 657/7 619), respectively. The top 5 species were H. influenzae(20.4%), S. pneumoniae(15.4%), S.aureus(9.8%), E. coli(9.5%), and Klebsiella spp.(9.2%). The main sources of specimens were respiratory tract(60.8%), eye discharge(16.1%), blood(6.6%), abscess(6.1%), and urine(2.8%). The prevalence of methicillin-resistant strains was 36.0% in S. aureus and 72.2% in coagulase-negative Staphylococcus. Vancomycin-resistant Enterococcus was identified in one strain of E. faecalis and one strains of E. faecium. The prevalence of PISP and PRSP was 0.8% and 0.3%, respectively. S. pneumoniae isolates showed high resistance rate to erythromycin, clindamycin, tetracycline, and trimethoprim-sulfamethoxazole. The prevalence of ESBLs-producing strains was 72.1% in E. coli and 75.6% in K. pneumoniae. A total of 263 carbapenem-resistant Enterobacteriaceae(CRE) strains were identified in 2017, including 219 carbapenem-resistant A.baumannii strains and 45 carbapenem-resistant P. aeruginosa strains. About 40.4% of the 1 556 H. influenzae strains were positive for β-lactamase. Overall, 63.3% and 88.9% of these H.influenzae strains were resistant to ampicillin and trimethoprimsulfamethoxazole, respectively. Conclusions Antimicrobial resistance is on the rise in the bacterial pathogens isolated from children. The prevalence of multidrug resistant strains such as CRE increased rapidly in recent years. Antimicrobial resistance monitoring and rational antibiotic use should be further strengthened.
引文
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[9]田磊,陈中举,孙自镛,等.2005-2014年CHINET肠杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(3):275-283.
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[11]LIU L,YU J,TANG M,et al.Mechanisms of resistance in clinical isolates of Enterobacter cloacae that are less susceptible to cefepime than to ceftazidime[J].Ann Clin Lab Sci,2018,48(3):355-362.
[12]BECEIRO A,MAHARJAN S,GAULTON T,et al.False extended-spectrum-lactamase phenotype in clinical isolates of Escherichia coli associated with increased expression of OXA-1or TEM-1 penicillinases and loss of porins[J].J Antimicrob Chemother,2011,66(9):2006-2010.
[13]曾章锐,王卫萍,黄梅,等.临床分离的铜绿假单胞菌对头孢吡肟敏感性低于头孢他啶的机制研究[J].检验医学,2014,29(11):1178-1183.
[14]张辉,张小江,徐英春,等.2005-2014年CHINET不动杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(4):429-436.
[15]徐英春,肖永红,卓超,等.中国碳青霉烯类耐药肠杆菌科细菌的流行病学和防控策略[J].中国执业药师,2013,10(4):3-8.
[16]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则2015年版[M].北京:人民卫生出版社,2015.
[17]孙燕,孔菁,张泓,等.2005-2014年CHINET流感嗜血杆菌和卡他莫拉菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):153-159.
[18]秦惠宏,王春,潘芬,等.儿童呼吸道分离流感嗜血杆菌的耐药性和基因分型[J].中国感染与化疗杂志,2017,17(5):532-537.
[2]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[3]王传清,王爱敏,俞蕙,等.2016年儿童细菌耐药监测[J].中华儿科杂志,2018,56(1):29-33.
[4]陈玲,曹明杰,谢强,等.安徽省滁州市儿童医院2014年临床分离菌的耐药性监测[J].中国感染与化疗杂志,2017,17(1):37-41.
[5]董方,王艳,刘锡青,等.2009-2015年北京儿童医院临床分离细菌的分布及耐药性监测[J].中国感染与化疗杂志,2017,17(1):61-70.
[6]MENDES R E,FLAMM R K,HOGAN P A,et a1.Summary of linezolid activity and resistance mechanisms detected during the 2012 LEADER surveillance program for the United States[J].Antimicrob Agents Chemother,2014,58(2):1243-1247.
[7]AMIN A N,CERCEO E A,DEITELZWEIG S B,et a1.The hospitalist perspective on treatment of community-acquired bacterial pneumonia[J].Postgrad Med,2014,126(2):18-29.
[8]景春梅,王偲.2015年重庆医科大学附属儿童医院细菌耐药性监测[J].中国感染与化疗杂志,2017,17(4):413-420.
[9]田磊,陈中举,孙自镛,等.2005-2014年CHINET肠杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(3):275-283.
[10]祝俊英,王春,张泓,等.2005-2014年CHINET儿童患者分离革兰阴性菌耐药性监测[J].中国感染与化疗杂志,2016,16(4):437-448.
[11]LIU L,YU J,TANG M,et al.Mechanisms of resistance in clinical isolates of Enterobacter cloacae that are less susceptible to cefepime than to ceftazidime[J].Ann Clin Lab Sci,2018,48(3):355-362.
[12]BECEIRO A,MAHARJAN S,GAULTON T,et al.False extended-spectrum-lactamase phenotype in clinical isolates of Escherichia coli associated with increased expression of OXA-1or TEM-1 penicillinases and loss of porins[J].J Antimicrob Chemother,2011,66(9):2006-2010.
[13]曾章锐,王卫萍,黄梅,等.临床分离的铜绿假单胞菌对头孢吡肟敏感性低于头孢他啶的机制研究[J].检验医学,2014,29(11):1178-1183.
[14]张辉,张小江,徐英春,等.2005-2014年CHINET不动杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(4):429-436.
[15]徐英春,肖永红,卓超,等.中国碳青霉烯类耐药肠杆菌科细菌的流行病学和防控策略[J].中国执业药师,2013,10(4):3-8.
[16]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则2015年版[M].北京:人民卫生出版社,2015.
[17]孙燕,孔菁,张泓,等.2005-2014年CHINET流感嗜血杆菌和卡他莫拉菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):153-159.
[18]秦惠宏,王春,潘芬,等.儿童呼吸道分离流感嗜血杆菌的耐药性和基因分型[J].中国感染与化疗杂志,2017,17(5):532-537.