【摘要】 目的 了解各类医疗机构门急诊和住院患儿临床分离菌的菌种组成和耐药性异同点，提供合理用药的实验室依据。方法 分别收集并统计CHINET 2015—2021年临床门急诊和住院患儿临床分离病原菌及药敏资料。结果 2015—2021年CHINET耐药监测网中儿童患者分离株共278 471株，其中门急诊分离株占17.1%，以A群β溶血链球菌、大肠埃希菌和金黄色葡萄球菌最常见；住院分离株占82.9%，以金黄色葡萄球菌、大肠埃希菌和流感嗜血杆菌最常见。门急诊耐甲氧西林金黄色葡萄球菌（MRSA）的检出率（24.5%）低于住院患儿（31.5%），且门急诊MRSA分离株对多种受试药物的耐药率均低于住院患儿。门急诊和住院患儿耐万古霉素的粪肠球菌或屎肠球菌和青霉素耐药肺炎链球菌检出率均较低，肺炎链球菌、β溶血链球菌和草绿色链球菌对红霉素的耐药率均较高，且门急诊红霉素耐药的A群β溶血链球菌的检出率高于住院患儿。门急诊患儿产β内酰胺酶流感嗜血杆菌的检出率（45.1%）低于住院患儿（59.4%），且均总体呈上升趋势。门急诊和住院患儿耐碳青霉烯类肺炎克雷伯菌（CRKpn）、耐碳青霉烯类铜绿假单胞菌（CRPae）和耐碳青霉烯类鲍曼不动杆菌（CRAba）的检出率分别为14.0%和24.2%、11.7%和20.6%、47.8%和52.8%。门急诊患儿分离的大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌、铜绿假单胞菌和鲍曼不动杆菌对多种受试药物的耐药率均低于住院患儿。门急诊患儿氟喹诺酮类耐药大肠埃希菌、产ESBL的肺炎克雷伯菌和奇异变形杆菌、耐碳青霉烯类大肠埃希菌（CREco）、CRKpn和CRPae的检出率均低于住院患儿，但2021年CRAba的检出率高于住院患儿。结论 门急诊和住院儿童患者中临床分离菌的分布不同，MRSA、ESBL和耐碳青霉烯类革兰阴性菌（CRO）等菌株在住院儿童中的检出率均高于门急诊患儿。临床应依据病原学诊断和药敏试验结果合理使用抗生素，持续做好耐药监测和医院感染防控，对遏制细菌耐药至关重要。更多还原

【Abstract】 Objective To understand the changing composition and antibiotic resistance of bacterial species in the clinical isolates from outpatient and emergency department(hereinafter referred to as outpatients) and inpatient children over time in various hospitals, and to provide laboratory evidence for rational antibiotic use. Methods The data on clinically isolated pathogenic bacteria and antimicrobial susceptibility of isolates from outpatients and inpatient children in the CHINET program from 2015 to 2021 were collected and analyzed. Results A total of 278 471 isolates were isolated from pediatric patients in the CHINET program from 2015 to 2021. About 17.1% of the strains were isolated from outpatients, primarily group A β-hemolytic Streptococcus, Escherichia coli,and Staphylococcus aureus. Most of the strains(82.9%) were isolated from inpatients, mainly S. aureus, E. coli, and H. influenzae.The prevalence of methicillin-resistant S. aureus(MRSA) in outpatients(24.5%) was lower than that in inpatient children(31.5%).The MRSA isolates from outpatients showed lower resistance rates to the antibiotics tested than the strains isolated from inpatient children. The prevalence of vancomycin-resistant Enterococcus faecalis or E. faecium and penicillin-resistant S. pneumoniae was low in either outpatients or inpatient children. S. pneumoniae, β-hemolytic Streptococcus and S. viridans showed high resistance rates to erythromycin. The prevalence of erythromycin-resistant group A β-hemolytic Streptococcus was higher in outpatients than that in inpatient children. The prevalence of β-lactamase-producing H. influenzae showed an overall upward trend in children, but lower in outpatients(45.1%) than in inpatient children(59.4%). The prevalence of carbapenem-resistant Klebsiella pneumoniae(CRKpn),carbapenem-resistant Pseudomonas aeruginosa(CRPae) and carbapenem-resistant Acinetobacter baumannii(CRAba) was 14%,11.7%, 47.8% in outpatients, but 24.2%, 20.6%, and 52.8% in inpatient children, respectively. The prevalence of multidrug-resistant E. coli, K. pneumoniae, Proteus mirabilis, P. aeruginosa and A. baumannii strains was lower in outpatients than in inpatient children.The prevalence of fluoroquinolone-resistant E. coli, ESBLs-producing K. pneumoniae, ESBLs-producing P. mirabilis, carbapenemresistant E. coli(CREco), CRKpn, and CRPae was lower in children in outpatients than in inpatient children, but the prevalence of CRAba in 2021 was higher than in inpatient children. Conclusions The distribution of clinical isolates from children is different between outpatients and inpatients. The prevalence of MRSA, ESBL, and CRO was higher in inpatient children than in outpatients.Antibiotics should be used rationally in clinical practice based on etiological diagnosis and antimicrobial susceptibility test results.Ongoing antimicrobial resistance surveillance and prevention and control of hospital infections are crucial to curbing bacterial resistance.更多还原