摘要
目的了解2020—2022年河北省儿童医院临床病原菌的分布及抗菌药物使用情况,为临床合理选用抗菌药物提供依据。方法采用纸片扩散法(K-B法)、梅里埃自动化仪器VITEK-2 Compact、BD Phoenix 100和E试验方法检测药物敏感性,结果参考美国临床和实验室标准化协会(CLSI)2022年文件标准判断,用WHONET 5.6软件对该院分离细菌耐药性进行统计分析。结果2020—2022年共分离11909株非重复临床菌株,革兰阳性菌和革兰阴性菌分别占45.1%和54.9%。金黄色葡萄球菌中甲氧西林耐药株检出率为36.8%,凝固酶阴性葡萄球菌中甲氧西林耐药株检出率为73.8%。粪肠球菌和屎肠球菌对氨苄西林的耐药率分别为2.6%和93.5%,对高浓度庆大霉素的耐药率分别为42.2%和66.2%,屎肠球菌对测试抗菌药物的耐药率均明显高于粪肠球菌。肺炎链球菌中非脑脊液标本分离株中青霉素耐药肺炎链球菌和青霉素敏感肺炎链球菌分别为1.7%和95.7%。未发现万古霉素和利奈唑胺耐药的葡萄球菌属、肠球菌属和链球菌属。大肠埃希菌和肺炎克雷伯菌中超广谱β内酰胺酶检出率分别为47.4%和32.3%,两种细菌碳青霉烯类耐药菌株的检出率分别为2.0%和22.4%。碳青霉烯类耐药铜绿假单胞菌和鲍曼不动杆菌检出率分别为9.5%和22.1%。流感嗜血杆菌对氨苄西林耐药率为83.8%,β内酰胺酶阳性率为76.1%,β内酰胺酶阴性氨苄西林耐药的流感嗜血杆菌检出率为7.7%。未发现对美罗培南耐药的流感嗜血杆菌。卡他莫拉菌中β内酰胺酶产酶株占98.0%。结论多重耐药菌株在儿童中的感染形势严峻,临床分离的常见细菌对不同抗菌药物的耐药率不同,应重视儿童细菌耐药监测,积极采取措施遏制耐药细菌的传播,合理使用抗菌药物。
Objective To investigate the distribution and antimicrobial resistance profiles of pathogenic bacteria in Children's Hospital of Hebei Province to inform reasonable use of antibiotics.Methods Antimicrobial susceptibility of the bacterial isolates was tested using Kirby-Bauer method,VITEK-2 Compact,BD Phoenix 100 automated systems,and E-test method.The results were interpreted according to the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2022.Results were analyzed by WHONET 5.6 software.Results A total of 11909 isolates were collected from 2020 to 2022,of which 45.1%were Gram positive organisms and 54.9%were Gram negative organisms.The prevalence of MRSA and in S.aureus and MRCNS in coagulase-negative Staphylococcus was 36.8%and 73.8%,respectively.The resistance rate of Enterococcus faecalis and Enterococcus faecium to ampicillin was 2.6%and 93.5%,respectively,while the resistance rates of E.faecalis and E.faecium to high concentration gentamicin was 42.2%and 66.2%,respectively.E.faecium showed significantly higher resistance rates to the antibiotics tested than E.faecalis.The prevalence of PRSP and PSSP was 1.7%and 95.7%respectively in the non-meningitis S.pneumoniae isolates.No vancomycin-or linezolid-resistant strains were found in Staphylococcus,Enterococcus,or Streptococcus.The prevalence of ESBLs-producing E.coli and K.pneumoniae was 47.4%and 32.3%,respectively.The prevalence of carbapenem-resistant E.coli and K.pneumoniae was 2.0%and 22.4%,respectively.The prevalence of carbapenem-resistant P.aeruginosa(CRPA)and carbapenem-resistant A.baumannii(CRAB)was 9.5%and 22.1%,respectively.The resistance rate of Haemophilus influenzae to ampicillin was 83.8%.The prevalence ofβ-lactamase-producing H.influenzae andβ-lactamase-non-producing ampicillin-resistant(BLNAR)H.influenzae was 76.1%and 7.7%,respectively.No meropenem-resistant strains were found in H.influenzae.Majority(98.0%)of Moraxella catarrhalis strains producedβ-lactamase.Conclusions Multidrug resistant bacterial pathogens are still serious in pediatric inpatients.The common clinical isolates showed various levels of resistance to different antimicrobial agents.It is important to continue the surveillance of bacterial resistance in children,take proactive measures to curb the spread of drug-resistant bacteria,and use antibiotics rationally.
作者
李梅
徐茜茹
张文超
曹贝贝
史楠楠
何宝花
贾肇一
郭映辉
LI Mei;XU Qianru;ZHANG Wenchao;CAO Beibei;SHI Nannan;HE Baohua;JIA Zhaoyi;GUO Yinghui(Department of Laboratory Medicine,Children’s Hospital of Hebei Province,Shijiazhuang 050031,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2024年第6期700-707,共8页
Chinese Journal of Infection and Chemotherapy
基金
河北省科技厅指令性项目科技专项(19277769D)
河北省科技计划项目(182777177)
河北省医学科学研究课题计划(20240777)。
