2016—2019年河北省儿童血培养检出病原菌及其耐药性变迁

Change in isolation and antimicrobial resistance of pathogens from blood culture of children in Hebei Province from 2016 to 2019

摘要:

目的 了解河北省细菌耐药监测网74所医院2016—2019年儿童患者血培养病原菌的分布及耐药性变迁。 方法 应用WHONET软件回顾性分析45所三级医院、29所二级医院儿童患者血培养病原菌分布及药敏特点；应用SPSS 19.0软件进行统计分析。 结果 剔除重复菌株后，2016—2019年儿童住院患者血培养分离菌株共7 591株，革兰阳性菌占71.7%，革兰阴性菌占28.3%。在本研究定义的4个年龄段内，金黄色葡萄球菌、嗜麦芽窄食单胞菌所占比率随年龄增加而增多。肺炎克雷伯菌对亚胺培南、美罗培南的耐药率为7.8%~35.5%。4年间，耐碳青霉烯类肺炎克雷伯菌（CRKP）检出率呈上升趋势（由12.9%上升至30.1%），耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率呈下降趋势（由81.7%下降至75.2%）。 结论 河北省儿童住院患者血培养病原菌以革兰阳性菌为主，与成人血培养病原菌分布不同，病原菌存在年龄分布差异，临床经验性治疗儿童血流感染时应注意儿童血培养的特点。

Abstract:

Objective To understand the distribution and antimicrobial resistance changes of pathogens from blood culture of children in 74 hospitals of monitoring network of antimicrobial resistance of pathogen in Hebei Province from 2016 to 2019. Methods WHONET software was used to retrospectively analyze the distribution and antimicrobial susceptibility characteristics of pathogens from blood culture of children in 45 tertiary hospitals and 29 se-condary hospitals. Results After eliminating repeated strains, a total of 7 591 strains were isolated from blood culture of hospitalized children from 2016 to 2019, Gram-positive bacteria and Gram-negative bacteria accounting for 71.7% and 28.3% respectively. In the four age groups defined in this study, the proportion of Staphylococcus aureus and Stenotrophomonas maltophilia increased with age. Resistance rates of Klebsiella pneumoniae to imipenem and meropenem were 7.8%-35.5%. In the past 4 years, isolation rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) showed an upward trend (from 12.9% to 30.1%), isolation rate of methicillin-resistant coagulase negative staphylococcus (MRCNS) showed a downward trend (from 81.7% to 75.2%). Conclusion Gram-positive bacteria are the main pathogens of blood culture of hospitalized children in Hebei Province, distribution of pathogens is different from that of adult blood culture. Distribution of pathogens varied with age, attention should be paid to the characteristics of blood culture of children in clinical empirical treatment of blood stream infection in children.