| 熊玉玲,岳美娜,邵启民,李冉,朱玉林.2018-2020年杭州地区儿童金黄色葡萄球菌耐药监测及D试验研究*[J].浙江中西医结合杂志,2021,31(10): |
| 2018-2020年杭州地区儿童金黄色葡萄球菌耐药监测及D试验研究* |
| Antimicrobial resistance surveillance and D test in Children Infected with Staphylococcus aureus in Hangzhou from 2018 to 2020 |
| 投稿时间：2021-01-20 修订日期：2021-08-06 |
| DOI： |
| 中文关键词: 儿童感染 金黄色葡萄球菌 耐甲氧西林金黄色葡萄球菌 甲氧西林敏感金黄色葡萄球菌 D试验 |
| 英文关键词:childhood infection Staphylococcus aureus Methicillin-resistant Staphylococcus aureus Methicillin-sensitive Staphylococcus aureus D test |
| 基金项目:安徽省自然科学基金(编号：1408085QH157) |
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| 中文摘要: |
| 目的：对儿童金黄色葡萄球菌(Staphylococcus aureus, SA)尤其是耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus, MRSA)的感染情况进行分析,并对药敏试验及克林霉素诱导耐药试验(D试验)结果进行分析,为临床规范、合理使用抗菌药物提供有效指导。方法：选取2018年1月-2020年12月杭州地区儿科门诊及住院患儿送检的病原学标本,去除同一患儿、相同部位的重复菌株,选取其中检出SA的标本968株作为研究对象。进行细菌培养、细菌分离鉴定、药敏试验及D试验操作,对不同年份、年龄、来源及病种的MRSA层次分布进行描述及比较,并分析MRSA及甲氧西林敏感金黄色葡萄球菌(Methicillin-sensitive Staphylococcus aureus, MSSA)的多药耐药性。依据年龄分布将患者分为低龄组（≤2岁）和高龄组（>2岁，并分析其耐药性的差异。结果：(1)本次研究纳入儿童SA标本968株,其中MRSA 258株(占比26.65%)。年份分布：自2018年到2020年,MRSA的构成比由34.11%提升为41.86%；检出率依次为23.53%、26.50%、30.00%。年龄分布：低龄组的MRSA构成比(75.58%)明显高于高龄组(24.42%)。来源分布：咽拭子标本的送检率最高,为60.54%；但痰液标本的MRSA构成比最高,为62.40%。病种分布：以肺炎的MRSA构成比最高,为66.28%。(2)对红霉素耐药而对克林霉素敏感的菌株为33.88%；其中D试验阳性为82.93%。MRSA的D试验阳性率为93.75%,MSSA的D试验阳性率为80.30%；两者比较差异显著(P<0.05)。(3)MRSA对于青霉素、红霉素、克林霉素的耐药率均高于MSSA,两者比较差异显著(均P<0.05)；而MRSA及MSSA在其余抗菌药物中的耐药率差异较小(均P>0.05)；其中两者对万古霉素、替加环素、利奈唑胺及喹奴普汀/达福普汀均存在完全敏感性。(4)低龄组的青霉素、红霉素及克林霉素等抗菌药物的耐药率均高于高龄组；两者比较差异显著(均P<0.05)；而其余抗菌药物中的耐药率差异较小(均P>0.05)。结论：儿童MRSA的感染率逐年增长,且低龄者具有更高的易感性。儿童MRSA的感染部位以呼吸道为主,尤其对于咽拭子等呼吸道标本出现可疑定植时应引发高度重视。MRSA具有广谱耐药性,应完善对耐药菌定植患儿的病原菌及耐药性监测,减少耐药菌的传递及感染。 |
| 英文摘要: |
| Objective: Staphylococcus aureus (SA) especially Methicillin-resistant Staphylococcus aureus (MRSA) in children infection was analyzed, and the results of drug susceptibility test and clindamycin-induced resistance test (D test) were analyzed to provide effective guidance for the clinical standardization and rational use of antibiotics. Methods: From January 2018 to December 2020, 968 SA samples were selected from the different children and non-repeated strains from the different hospital of Hangzhou. Bacterial culture, bacterial isolation and identification, drug susceptibility test and D test operation were carried out to describe and compare the MRSA hierarchical distribution of different years, ages, sources, and disease types, and to analyze the multidrug resistance of MRSA and Methicillin-sensitive Staphylococcus aureus (MSSA).Patients were divided into younger (≤2 years) and older ( >2 years) groups according to age distribution, and the differences of drug resistance were analyzed. Results: (1) In this study, 968 children"s SA specimens were included, including 258 MRSA specimens (26.65%).Year distribution: from 2018 to 2020, the proportion of MRSA increased from 34.11% to 41.86%; The positive rates of MRSA were 23.53%, 26.50%, 30.00%. Age distribution: the composition ratio of MRSA in low age group (75.58%) was significantly higher than that in old age group (24.42%). Source distribution: pharyngeal swab specimens had the highest MRSA rate of 60.54%, but sputum specimens had the highest MRSA ratio of 62.40%. The proportion of MRSA in pneumonia was the highest, which was 33.88%.(2) 31.77% was resistant to erythromycin but sensitive to clindamycin; 82.93% was positive rate for D test.There was 93.75% positive rate in the D test of MRSA and 80.30% positive rate in the D test of MSSA. The difference between them was significant (P<0.05).(3) The resistance rates of MRSA to penicillin, erythromycin and clindamycin were higher than those of MSSA, and the difference between them was significant (all P < 0.05); while the resistance rates of MRSA and MSSA to other antimicrobial drugs were slightly different (all P > 0.05); both of them had complete sensitivity to vancomycin, tigecycline, linezolid and furantoin.(4) The resistance rates of penicillin, erythromycin and clindamycin in the younger age group were higher than those in the older age group; the difference between the two groups was significant (both P < 0.05); while the resistance rates of other antimicrobial drugs were smaller (all P > 0.05).Conclusion: The infection rate of MRSA in children is increasing year by year, and younger people have higher susceptibility. Respiratory tract is the main infection site of MRSA in children, especially when suspicious colonization occurs in respiratory specimens such as throat swabs, it should be paid great attention to. Children, especially the younger ones, are susceptible and have broad-spectrum resistance to MRSA. Therefore, the pathogenic bacteria and drug resistance monitoring of children colonized with drug-resistant bacteria should be improved to reduce the transmission and infection of drug-resistant bacteria. |
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