【摘要】 背景 中国儿童重症感染病原耐药监测协作网(China PICU pathogen surveillance network, CHIPS)于2021年成立，每年对国内18家三级甲等医院PICU细菌耐药监测数据进行汇总分析，以了解PICU主要感染细菌及其耐药情况。目的 分析2023年PICU主要感染细菌及其耐药性，以指导临床合理使用抗菌药物。设计横断面调查。方法 菌株资料来源于2023年1月1日至2023年12月31日国内18家三级甲等医院的PICU病房。细菌抗菌药物敏感性试验采用自动仪器法或纸片扩散法，结果判断采用美国临床实验室标准化委员会(Clinical Laboratory Standards Institute, CLSI)2023年标准。主要结局指标PICU主要的细菌分布及对抗菌药物的敏感性。结果 2023年CHIPS共分离5 706株非重复临床菌株，革兰阳性菌和革兰阴性菌分别占41.4%和58.6%。分离的前5位病原菌分别为金黄色葡萄球菌(17.5%),肺炎链球菌(8.8%),鲍曼不动杆菌(8.6%),肺炎克雷伯菌(8.4%),铜绿假单胞菌(7.6%)。下呼吸道是最主要的标本来源(68.6%),其最主要的分离株为金黄色葡萄球菌(21.5%)和肺炎链球菌(11.2%)。大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌分别检出403株、479株、489株、433株，其中碳青霉烯类耐药大肠埃希菌(carbapenem-resistant Escherichia coli, CRE)、碳青霉烯类耐药肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae, CRKP)、碳青霉烯类耐药鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii, CRAB)、碳青霉烯类耐药铜绿假单胞菌(carbapenem-resistant Pseudomonas aeruginosa, CRPA)的检出率分别为4.5%、20.0%、56.2%、19.9%。除天然耐药菌株外，其他非发酵革兰阴性杆菌和肠杆菌目细菌对替加环素、黏菌素、多黏菌素B均高度敏感，耐药率为0～2.6%。流感嗜血杆菌和卡他莫拉菌中β-内酰胺酶的检出率分别为69.9%和100%,对阿奇霉素的非敏感率分别为58.3%和47.7%。金黄色葡萄球菌、表皮葡萄球菌、人葡萄球菌人亚种分别检出999株、201株、145株，其中甲氧西林耐药金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)、甲氧西林耐药表皮葡萄球菌(methicillin-resistant Staphylococcus epidermidis, MRSE)和甲氧西林耐药人葡萄球菌人亚种(methicillin-resistant Staphylococcus hominis ss.hominis, MRSH)的检出率分别为36.9%、83.5%和84.9%,甲氧西林耐药菌株相比于甲氧西林敏感菌株对绝大多数抗菌药物表现出更高的耐药性，尚未检出万古霉素耐药株。结论 2023年，PICU患儿临床分离株对常用抗菌药物表现出高度耐药性，尤其是碳青霉烯类耐药革兰阴性杆菌和甲氧西林耐药葡萄球菌较儿童整体检出率更高。更多还原

【Abstract】 Background The China Pediatric Intensive Care Unit(PICU) Pathogen Surveillance Network(CHIPS) was established in 2021 to collect and analyze bacterial resistance monitoring data from PICUs at 18 tertiary hospitals in China annually to understand changes in infectious bacteria and their resistance patterns in PICUs. Objective To investigate the main infecting bacteria and their drug resistance in the PICU in 2023, aiming to guide the rational use of antibiotics in clinical practice. Design Cross-sectional study. Methods Bacterial strain data was collected from the PICU wards of 18 tertiary hospitals in China from January 1, 2023, to December 31, 2023. Antimicrobial susceptibility testing was performed using automated systems or the disk diffusion method. Testing results were interpreted according to Clinical and Laboratory Standards Institute(CLSI) 2023 breakpoints. Main outcome measures Distribution of bacteria in the PICU and their sensitivity to antibiotics. Results A total of 5706 non-repetitive bacteria were isolated from CHIPS in 2023, of which 41.4% were gram-positive organisms and 58.6% were gram-negative. The top five isolated pathogens were Staphylococcus aureus(17.5%), Streptococcus pneumoniae(8.8%), Acinetobacter baumannii(8.6%), Klebsiella pneumoniae(8.4%), and Pseudomonas aeruginosa(7.6%). The lower respiratory tract was the primary specimen(68.6%), and the most common bacteria were Staphylococcus aureus(21.5%) and Streptococcus pneumoniae(11.2%). A total of 403 strains of Escherichia coli, 479 strains of Klebsiella pneumoniae, 489 strains of Acinetobacter baumannii, and 433 strains of Pseudomonas aeruginosa were detected. The rates of carbapenem-resistant Escherichia coli(CRE), carbapenem-resistant Klebsiella pneumoniae(CRKP), carbapenem-resistant Acinetobacter baumannii(CRAB), and carbapenem-resistant Pseudomonas aeruginosa(CRPA) were 4.5%, 20.0%, 56.2%, and 19.9%, respectively. All the non-fermenting Gram-negative bacilli and Enterobacteriaceae exhibited high sensitivity to tigecycline, colistin, and polymyxin B, with resistance rates ranging from 0 to 2.6%, except for naturally resistant strains. The rates of β-lactamase in Haemophilus influenzae and Moraxella catarrhalis were 69.9% and 100%, respectively, with non-sensitivity to azithromycin at 58.3% and 47.7%, separately.There were 999 strains of Staphylococcus aureus, 201 strains of Staphylococcus epidermidis, and 145 strains of Staphylococcus hominis ss. hominis were detected. The prevalence of methicillin-resistant Staphylococcus aureus(MRSA), methicillin-resistant Staphylococcus epidermidis(MRSE), and methicillin-resistant Staphylococcus hominis ss. hominis(MRSH) were 36.9%, 83.5%, and 84.9%, respectively. Compared to methicillin-sensitive strains, methicillin-resistant strains exhibited higher resistance to most antibiotics, and no vancomycin-resistant strains were detected. Conclusion In 2023, clinical isolates from PICU patients exhibited high resistance to commonly used antibiotics, particularly carbapenem-resistant gram-negative bacilli and methicillin-resistant Staphylococcus aureus(MRSA), which were detected at higher rates compared to the overall pediatric population.更多还原