背景:抗生素耐药性是一个严重的全球公共卫生问题。然而,关于中国新生儿抗菌药物敏感性趋势的报道很少,现有的大部分证据都来自成人研究。我们的目的是评估中国患有侵袭性细菌感染(IBIs)的足月新生儿中常见病原体的抗菌药物敏感性趋势。
方法:这项横断面调查研究分析了来自17家医院的中国IBIs新生儿的抗菌药物敏感性,从2012年1月到2021年12月。应用Joinpoint回归模型来说明趋势并计算年平均百分比变化(AAPC)。使用Mantel-Haenszel线性-线性关联卡方检验,我们进一步比较了2019年至2021年间病原体的抗生素最低抑制浓度(MIC),以提供变化的精确估计.
结果:具有超广谱β-内酰胺酶阴性菌株的大肠杆菌比例从0.0增加到88.5%(AAPC=62.4%,95%置信区间(CI):44.3%,82.9%),2014年和2018年有两个断点(p趋势<0.001)。B组链球菌对红霉素和克林霉素的敏感性分别增加了66.7%和42.8%,分别(AAPC=55.2%,95%CI:23.2%,95.5%,p趋势=0.002;AAPC=54.8%,95%CI:9.6%,118.6%,p趋势<0.001),金黄色葡萄球菌对青霉素的影响也是如此(AAPC=56.2%;95%CI:34.8%,81.0%,p趋势<0.001)。然而,肠球菌属的敏感性。氨苄青霉素从100.0降至25.0%(AAPC=-11.7%,95%CI:-15.2%,-8.1%,p趋势<0.001),大肠杆菌对氨苄西林的抗生素敏感性没有显著改善,庆大霉素,和头孢菌素.此外,与2019年相比,2021年相关抗生素MIC值相对较低的GBS/金黄色葡萄球菌比例也有所上升。
结论:在过去十年中,中国足月新生儿中最流行的病原体的抗菌药物敏感性似乎有所改善或保持稳定。暗示抗生素管理政策和实践的有效性已经逐渐出现。
BACKGROUND: Antibiotic resistance is a serious global public health issue. However, there are few reports on trends in antimicrobial susceptibility in Chinese neonates, and most of the existing evidence has been derived from adult studies. We aimed to assess the trends in antimicrobial susceptibility of common pathogens in full-term neonates with invasive bacterial infections (IBIs) in
China.
METHODS: This cross-sectional survey study analyzed the antimicrobial susceptibility in Chinese neonates with IBIs from 17 hospitals, spanning from January 2012 to December 2021. Joinpoint regression model was applied to illustrate the trends and calculate the average annual percentage change (AAPC). Using Mantel-Haenszel linear-by-linear association chi-square test, we further compared the antibiotic minimum inhibitory concentrations (MICs) by pathogens between 2019 and 2021 to provide precise estimates of changes.
RESULTS: The proportion of Escherichia coli with extended-spectrum-beta-lactamase-negative strains increased from 0.0 to 88.5% (AAPC = 62.4%, 95% confidence interval (CI): 44.3%, 82.9%), with two breakpoints in 2014 and 2018 (p-trend < 0.001). The susceptibility of group B Streptococcus (GBS) to erythromycin and clindamycin increased by 66.7% and 42.8%, respectively (AAPC = 55.2%, 95% CI: 23.2%, 95.5%, p-trend = 0.002; AAPC = 54.8%, 95% CI: 9.6%, 118.6%, p-trend < 0.001), as did Staphylococcus aureus to penicillin (AAPC = 56.2%; 95% CI: 34.8%, 81.0%, p-trend < 0.001). However, the susceptibility of Enterococcus spp. to ampicillin declined from 100.0 to 25.0% (AAPC = - 11.7%, 95% CI: - 15.2%, - 8.1%, p-trend < 0.001), and no significant improvement was observed in the antibiotic susceptibility of Escherichia coli to ampicillin, gentamicin, and cephalosporin. Additionally, the proportion of GBS/Staphylococcus aureus with relatively low MIC values for relevant antibiotics also increased in 2021 compared to 2019.
CONCLUSIONS: Antimicrobial susceptibility of the most prevalent pathogens in full-term neonates seemed to have improved or remained stable over the last decade in
China, implying the effectiveness of policies and practice of antibiotic stewardship had gradually emerged.