2015-2017年重庆地区儿童和成人血培养分离革兰阴性菌分布及耐药性分析
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摘要
目的分析重庆地区血培养分离病原菌的分布和耐药性及患者年龄差异。方法回顾性分析2015-2017年重庆地区耐药监测网中血标本分离革兰阴性菌患者年龄分布特征,采用仪器配套药敏卡检测,药敏结果数据使用WHONET5.6和GraphpadPrism6进行分析。结果 3年血培养阳性非重复株20145株。检出排名前3位的革兰阴性菌是大肠埃希菌(56.7%,6688/11799)、肺炎克雷伯菌(19.6%,2308/11799)和铜绿假单胞菌(4.4%,522/11799)。大肠埃希菌对碳青霉烯类耐药率<1%,而肺炎克雷伯菌在5%左右,阴沟肠杆菌和黏质沙雷菌为9%左右。成人中大肠埃希菌对半数受试抗菌药物耐药率显著高于儿童,肺炎克雷伯菌则相反。鲍曼不动杆菌总体耐药率高于铜绿假单胞菌,成人中鲍曼不动杆菌对所测抗菌药物耐药率均显著高于儿童。结论重庆地区血培养阳性的革兰阴性菌中以大肠埃希菌和肺炎克雷伯菌为主。细菌对碳青霉烯类药物仍保持较高的敏感性。但儿童患者中分离的碳青霉烯类耐药肺炎克雷伯菌和成人患者中分离的碳青霉烯类耐药鲍曼不动杆菌应引起临床高度重视。
Objective To analyze the age difference of gram negative isolates(GNB) from blood culture and antibiotic resistance profile between children and adults. Methods Age difference of pathogen distribution of GNB isolated from blood culture during 2015-2017 were retrospectively analyzed. WHONET 5.6 and Graphpad Prism 6 were used to perform Chi-square test on the pathogen proportion and antibiotic resistance rate. Results A total of 20 145 bacterial strains were isolated in Chongqing from 2015 to 2017. The top three strains of GNB were E. coli(56.7%, 6 688/11 799), K. pneumoniae(19.6%, 2 308/11 799), and P. aeruginosa(4.4%, 522/11 799). The resistant rate of E. coli to carbapenems was less than 1%. The resistant rate of K. pneumoniae to carbapenems was about 5%, while the resistant rate of S. marcescens was approximately 9%, similar to E. cloacae. The overall resistance rates of E. coli from adult patients to most antiobiotic agents were significantly higher than those of children, but the overall resistance rate of K. pneumoniae from children was higher than those of adults. The drug resistance rate of A. baumannii was higher than P. aeruginosa. A. baumannii isolates from adult patients were highly resistant to all drugs tested and more resistant than those from pediatric patients. Conclusions Majority of GNB strains isolated from blood culture were E. coli and K. pneumoniae, for which carbapenems are still active. More attention should be paid to carbapenem-resistant K. pneumoniae from children and A. baumannii from adults. National surveillance of nosocomial bloodstream infection should be highly evaluated.
Objective To analyze the age difference of gram negative isolates(GNB) from blood culture and antibiotic resistance profile between children and adults. Methods Age difference of pathogen distribution of GNB isolated from blood culture during 2015-2017 were retrospectively analyzed. WHONET 5.6 and Graphpad Prism 6 were used to perform Chi-square test on the pathogen proportion and antibiotic resistance rate. Results A total of 20 145 bacterial strains were isolated in Chongqing from 2015 to 2017. The top three strains of GNB were E. coli(56.7%, 6 688/11 799), K. pneumoniae(19.6%, 2 308/11 799), and P. aeruginosa(4.4%, 522/11 799). The resistant rate of E. coli to carbapenems was less than 1%. The resistant rate of K. pneumoniae to carbapenems was about 5%, while the resistant rate of S. marcescens was approximately 9%, similar to E. cloacae. The overall resistance rates of E. coli from adult patients to most antiobiotic agents were significantly higher than those of children, but the overall resistance rate of K. pneumoniae from children was higher than those of adults. The drug resistance rate of A. baumannii was higher than P. aeruginosa. A. baumannii isolates from adult patients were highly resistant to all drugs tested and more resistant than those from pediatric patients. Conclusions Majority of GNB strains isolated from blood culture were E. coli and K. pneumoniae, for which carbapenems are still active. More attention should be paid to carbapenem-resistant K. pneumoniae from children and A. baumannii from adults. National surveillance of nosocomial bloodstream infection should be highly evaluated.
引文
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[3] HUYNH B T, PADGET M, GARIN B, et al. Bacterial neonatal sepsis and antibiotic resistance in low-income countries[J].Lancet,2016, 387(10018):533-534.
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[5]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.
[6]李光辉,朱德妹,汪复,等.2012年中国CHINET血培养临床分离菌的分布及耐药性[J].中国感染与化疗杂志,2014,14(6):474-481.
[7]张艳君,马秀珍,秦琴,等.血流感染病原菌的分布与耐药性分析[J].中国感染与化疗杂志,2017, 17(3):314-320.
[8]张杰,黄湘宁,龙姗姗,等.四川省细菌耐药监测网2016年血流感染病原菌分布和耐药分析[J].中国循证医学杂志,2017, 17(9):1011-1014.
[9] KUO F C, WANG S M, SHEN C F, et al. Bloodstreaminfections in pediatric patients with acute leukemia:Emphasis on gram-negative bacteria infections[J]. J Microbiol Immunol Infect, 2017, 50(4):507-513.
[10] TARIQ T M, RASOOL E. Emerging trends of bloodstream infections:a six-year study at a paediatric tertiary care hospital in Kabul[J]. J Coll Physicians Surg Pak, 2016, 26(11):887-891.
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[12] KEHL S C, DOWZICKY M J. Global assessment of antimicrobial susceptibility among Gram-negative organisms collected from pediatric patients between 2004 and 2012:results from the Tigecycline Evaluation and Surveillance Trial[J]. J Clin Microbiol, 2015, 53(4):1286-1293.
[13] LOGAN L K. Carbapenem-resistant enterobacteriaceae:an emerging problem in children[J]. Clin Infect Dis, 2012, 55(6):852-859.
[14] ZHANG X, CHEN D, XU G, et al. Molecular epidemiology and drug resistant mechanism in carbapenem-resistant Klebsiella pneumoniae isolated from pediatric patients in Shanghai, China.[J]. PLoS One, 2018, 13(3):e0194000.
[15] YAN J,PU S,JIAX,et al. Multidrug resistance mechanisms of carbapenem resistant Klebsiella pneumoniae strains isolated in Chongqing, China[J]. Ann Lab Med, 2017, 37(5):398-407.
[16] QI Y, WEI Z, JI S, et al. ST11, the dominant clone of KPCproducing Klebsiella pneumoniae in China[J]. J Antimicrob Chemother, 2011, 66(2):307-312.
[17] DONG F, LU J, WANG Y, et al. A five-year surveillance of carbapenemase-producing Klebsiella pneumoniae in a pediatric hospital in China reveals increased predominance of NDM-1[J].Biomed Environ Sci, 2017, 30(8):562-569.
[18] ZHU J, SUN L, DING B, et al. Outbreak of NDM-1-producing Klebsiella pneumoniae ST76 and ST37 isolates in neonates[J].Eur J Clin Microbiol Infect Dis, 2016, 35(4):611-618.
[19] JIN Y,SHAO C,LI J,et al. Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province, China[J]. PLoS One, 2015, 10(3):e0119571.
[20]翟如波,李云慧,孙跃岭,等.某院连续三年医院血流感染病原菌分布特征及耐药性分析[J].中华实验和临床感染病杂志(电子版),2016, 10(1):36-40.
[21]陈瑞娟,芮庆林,郭涛,等.重症监护病房血流感染的临床特点和病原学分析[J].中国感染与化疗杂志,2016, 16(6):673-679.
[2] FLEISCHMANN-STRUZEK C,GOLDFARB D M,SCHLATTMANN P, et al. The global burden of paediatric and neonatal sepsis:a systematic review[J]. Lancet Respir Med,2018, 6(3):223-230.
[3] HUYNH B T, PADGET M, GARIN B, et al. Bacterial neonatal sepsis and antibiotic resistance in low-income countries[J].Lancet,2016, 387(10018):533-534.
[4]董琳,张旭玉,李嫦嫦,等.儿童革兰阴性菌血流感染的流行病学及细菌耐药特征[J].中华儿科杂志,2017, 55(9):683-688.
[5]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.
[6]李光辉,朱德妹,汪复,等.2012年中国CHINET血培养临床分离菌的分布及耐药性[J].中国感染与化疗杂志,2014,14(6):474-481.
[7]张艳君,马秀珍,秦琴,等.血流感染病原菌的分布与耐药性分析[J].中国感染与化疗杂志,2017, 17(3):314-320.
[8]张杰,黄湘宁,龙姗姗,等.四川省细菌耐药监测网2016年血流感染病原菌分布和耐药分析[J].中国循证医学杂志,2017, 17(9):1011-1014.
[9] KUO F C, WANG S M, SHEN C F, et al. Bloodstreaminfections in pediatric patients with acute leukemia:Emphasis on gram-negative bacteria infections[J]. J Microbiol Immunol Infect, 2017, 50(4):507-513.
[10] TARIQ T M, RASOOL E. Emerging trends of bloodstream infections:a six-year study at a paediatric tertiary care hospital in Kabul[J]. J Coll Physicians Surg Pak, 2016, 26(11):887-891.
[11]刘萍,张坚磊,杨彬,等.2014年天津市血流感染细菌耐药监测[J].中国医院药学杂志,2017, 37(18):1787-1791.
[12] KEHL S C, DOWZICKY M J. Global assessment of antimicrobial susceptibility among Gram-negative organisms collected from pediatric patients between 2004 and 2012:results from the Tigecycline Evaluation and Surveillance Trial[J]. J Clin Microbiol, 2015, 53(4):1286-1293.
[13] LOGAN L K. Carbapenem-resistant enterobacteriaceae:an emerging problem in children[J]. Clin Infect Dis, 2012, 55(6):852-859.
[14] ZHANG X, CHEN D, XU G, et al. Molecular epidemiology and drug resistant mechanism in carbapenem-resistant Klebsiella pneumoniae isolated from pediatric patients in Shanghai, China.[J]. PLoS One, 2018, 13(3):e0194000.
[15] YAN J,PU S,JIAX,et al. Multidrug resistance mechanisms of carbapenem resistant Klebsiella pneumoniae strains isolated in Chongqing, China[J]. Ann Lab Med, 2017, 37(5):398-407.
[16] QI Y, WEI Z, JI S, et al. ST11, the dominant clone of KPCproducing Klebsiella pneumoniae in China[J]. J Antimicrob Chemother, 2011, 66(2):307-312.
[17] DONG F, LU J, WANG Y, et al. A five-year surveillance of carbapenemase-producing Klebsiella pneumoniae in a pediatric hospital in China reveals increased predominance of NDM-1[J].Biomed Environ Sci, 2017, 30(8):562-569.
[18] ZHU J, SUN L, DING B, et al. Outbreak of NDM-1-producing Klebsiella pneumoniae ST76 and ST37 isolates in neonates[J].Eur J Clin Microbiol Infect Dis, 2016, 35(4):611-618.
[19] JIN Y,SHAO C,LI J,et al. Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province, China[J]. PLoS One, 2015, 10(3):e0119571.
[20]翟如波,李云慧,孙跃岭,等.某院连续三年医院血流感染病原菌分布特征及耐药性分析[J].中华实验和临床感染病杂志(电子版),2016, 10(1):36-40.
[21]陈瑞娟,芮庆林,郭涛,等.重症监护病房血流感染的临床特点和病原学分析[J].中国感染与化疗杂志,2016, 16(6):673-679.