儿科传染病监测(ISPED)计划于2015年建立,旨在监测和分析儿童细菌流行病学和抗生素耐药性(AMR)的趋势。收集了2016年至2020年中国11家三级保健儿童医院的临床细菌分离株。使用Kirby-Bauer方法或自动化系统进行抗菌药敏感性测试,根据临床和实验室标准研究所2019断点进行解释。共收集到288,377株分离株,前10名主要细菌是大肠杆菌,肺炎链球菌,金黄色葡萄球菌,流感嗜血杆菌,肺炎克雷伯菌,卡他莫拉菌,化脓性链球菌,表皮葡萄球菌,铜绿假单胞菌,和鲍曼不动杆菌.2020年,2019年冠状病毒病(COVID-19)大流行年,我们观察到呼吸道样本的比例显着降低(从56.9%降至44.0%)。在主要从呼吸道样本中分离的主要细菌中也看到了相当的减少,包括肺炎链球菌,流感嗜血杆菌,和化脓性链球菌。儿童中常见的多药耐药菌(MDRO),其耐药率高于敏感菌株。耐碳青霉烯类肺炎克雷伯菌(CRKP)的比例,耐碳青霉烯类鲍曼不动杆菌(CRAB),耐碳青霉烯铜绿假单胞菌(CRPA),耐甲氧西林金黄色葡萄球菌(MRSA)占19.7%,46.4%%,12.8%,和35.0%,分别。CRKP的比例,CRAB,和CRPA菌株在2015年至2020年期间均呈下降趋势。耐碳青霉烯类肠杆菌(CRE)和CRPA随年龄增长而逐渐降低,而CRAB则表现出与年龄相反的趋势。CRE和CRPA都对新生儿构成潜在威胁。MDRO显示出很高的AMR水平,已经成为对儿童的紧迫威胁,这表明中国儿童需要有效监测AMR和抗菌药物管理。重要性AMR,特别是涉及多药耐药生物(MDROs),被认为是对人类健康的全球性威胁;AMR使感染越来越难以治疗,构成了巨大的经济负担,并对患者的发病率和死亡率产生了巨大的负面影响。世界上有许多监测计划来解决人类的AMR谱和MDRO患病率。然而,已发表的评估儿童总体AMR率或MDRO分布的研究非常有限或质量参差不齐.在这项研究中,我们首次展示了2016-2020年中国儿童主要病原菌的细菌流行病学和耐药谱,分析了MDRO随时间和年龄的分布,并描述了MDRO对儿童的潜在威胁,尤其是低免疫力的新生儿。我们的研究将对指导中国儿童的抗感染治疗非常有用,以及世界各地的儿科患者。
The Infectious Disease Surveillance of Pediatrics (ISPED) program was established in 2015 to monitor and analyze the trends of bacterial epidemiology and antimicrobial resistance (AMR) in children. Clinical bacterial isolates were collected from 11 tertiary care children\'s hospitals in
China in 2016 to 2020. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer method or automated systems, with interpretation according to the Clinical and Laboratory Standards Institute 2019 breakpoints. A total of 288,377 isolates were collected, and the top 10 predominant bacteria were Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Acinetobacter baumannii. In 2020, the coronavirus disease 2019 (COVID-19) pandemic year, we observed a significant reduction in the proportion of respiratory tract samples (from 56.9% to 44.0%). A comparable reduction was also seen in the primary bacteria mainly isolated from respiratory tract samples, including S. pneumoniae, H. influenzae, and S. pyogenes. Multidrug-resistant organisms (MDROs) in children were commonly observed and presented higher rates of drug resistance than sensitive strains. The proportions of carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant A. baumannii (CRAB), carbapenem-resistant P. aeruginosa (CRPA), and methicillin-resistant S. aureus (MRSA) strains were 19.7%, 46.4%%, 12.8%, and 35.0%, respectively. The proportions of CRKP, CRAB, and CRPA strains all showed decreasing trends between 2015 and 2020. Carbapenem-resistant Enterobacteriaceae (CRE) and CRPA gradually decreased with age, while CRAB showed the opposite trend with age. Both CRE and CRPA pose potential threats to neonates. MDROs show very high levels of AMR and have become an urgent threat to children, suggesting that effective monitoring of AMR and antimicrobial stewardship among children in
China are required. IMPORTANCE AMR, especially that involving multidrug-resistant organisms (MDROs), is recognized as a global threat to human health; AMR renders infections increasingly difficult to treat, constituting an enormous economic burden and producing tremendous negative impacts on patient morbidity and mortality rates. There are many surveillance programs in the world to address AMR profiles and MDRO prevalence in humans. However, published studies evaluating the overall AMR rates or MDRO distributions in children are very limited or are of mixed quality. In this study, we showed the bacterial epidemiology and resistance profiles of primary pathogens in Chinese children from 2016 to 2020 for the first time, analyzed MDRO distributions with time and with age, and described MDROs\' potential threats to children, especially low-immunity neonates. Our study will be very useful to guide antiinfection therapy in Chinese children, as well as worldwide pediatric patients.