Objective: To investigate the changes of the distribution and drug resistance profile of bacteria from ICU children with lower respiratory tract infection (LRTI) in Suzhou City, Jiangsu Province from 2017 to 2022. Methods: From January 2017 to December 2022, a cross-sectional observational study on the bacterial spectrum analysis among intensive care unit (ICU) children with LRTI was conducted in Children's Hospital of Soochow University. The bacteria was cultivated by culture methods from sputum samples, and identified by MALDI-TOF mass spectrometry. Drug sensitivity tests were performed by the VITEK2 Compact fully automated analysis system and the paper slide method. The χ2 test or Fisher's exact probability was used to analyze the changes of the distribution of sputum culture-positive bacteria and drug resistance in ICU children. Results: The overall detection rate of sputum culture was 42.06% (1 182/2 810). Staphylococcus aureus (25.63%,303/1 182), Acinetobacter baumannii (13.62%,161/1 182) and Haemaphilus influenzae (13.28%,157/1 182) were the top three. Proportions of Acinetobacter baumannii (17.90% vs. 11.02%,χ²=11.17, P=0.001), especially carbapenem-resistant Acinetobacter baumannii (43.70% vs. 23.50%, χ²=15.21, P<0.001) increased significantly from 2020 to 2022. However, the proportions of Haemophilus influenzae (8.50% vs. 16.19%, χ²=14.27, P<0.001), Streptococcus pneumoniae (8.50% vs. 15.92%, χ²=13.42, P<0.001) and extended-spectrum-lactamase producing Escherichia coli (8.89% vs. 18.00%, χ²=5.45, P=0.025) decreased. Drug resistant results showed that Acinetobacter baumannii was obviously more resistant to imipenem (χ²=4.43, P=0.035) and levofloxacin (χ²=12.53, P<0.001), while more sensitive to minocycline (χ²=8.34, P=0.004). Escherichia coli showed a significant increase in resistance to piperacillin tazobactam (χ²=8.29, P=0.008) and cefoperazone sulbactam (χ²=5.07, P=0.024) from 2020 to 2022; Klebsiella pneumoniae consistently maintained a resistance rate of more than 60% to first and second-generation cephalosporins, and remain susceptible to quinolones and carbapenems. Staphylococcus aureus remained highly susceptible to levofloxacin (drug resistance rate: 2.31%,7/303) and sulfamethoxazole/trimethoprim (drug resistance rate: 4.95%,15/303) from 2020 to 2022. Conclusion: Higher detection and resistance rates of Acinetobacter baumannii from sputum culture in ICU children from 2020 to 2022 were explored. Resistance of Escherichia coli to β-lactamase inhibitor combinations was more serious. Regular monitoring the changes of the etiology of respiratory tract infections in ICU Children is particularly important for the prevention and treatment of multidrug-resistant bacterial infections.
目的： 探讨江苏省苏州地区2017—2022年重症监护室儿童下呼吸道感染（LRTI）病原菌分布及耐药特征变化。 方法： 采用横断面观察性研究方法，收集2017年1月至2022年12月在苏州大学附属儿童医院重症监护室的1 182例LRTI患儿，年龄1.00（0.25，4.00）岁，男性728例，女性454例。收集痰液标本采用细胞培养法检测病原菌，通过MALDI-TOF质谱仪进行细菌鉴定，并联合VITEK2 Compact全自动分析系统和纸片法进行药敏试验。运用χ2检验或Fisher确切概率法比较2017—2019年和2020—2022年ICU儿童痰培养阳性菌的分布和耐药性改变。 结果： 痰培养总体检出率42.06%（1 182/2 810），检出前三位的菌株为金黄色葡萄球菌（25.63%，303/1 182）、鲍曼不动杆菌（13.62%，161/1 182）和流感嗜血杆菌（13.28%，157/1 182）。2020—2022年鲍曼不动杆菌（17.90% vs. 11.02%，χ²=11.17，P=0.001），尤其是耐碳青霉烯类鲍曼不动杆菌（43.70% vs. 23.50%，χ²=15.21，P<0.001）比例较2017—2019年显著上升；而2020—2022年流感嗜血杆菌（8.50% vs. 16.19%，χ²=14.27，P<0.001）、肺炎链球菌（8.50% vs. 15.92%，χ²=13.42，P<0.001）和产超广谱-内酰胺酶大肠埃希菌（8.89% vs. 18.00%，χ²=5.45，P=0.025）比例较2017—2019年明显下降。药敏结果显示，2020—2022年鲍曼不动杆菌对亚胺培南（χ²=4.43，P=0.035）和左氧氟沙星（χ²=12.53，P<0.001）耐药性较2017—2019年明显增加，而对米诺环素（χ²=8.34，P=0，004）耐药率减低。2020—2022年大肠埃希菌对哌拉西林/他唑巴坦（χ²=8.29，P=0.008）、头孢哌酮/舒巴坦（χ²=5.07，P=0.024）的耐药率显著增加；肺炎克雷伯菌对一代、二代头孢菌素耐药率始终保持在60%以上，对喹诺酮类和碳青霉烯类药物敏感。2020—2022年金黄色葡萄球菌对左氧氟沙星（耐药率2.31%，7/303）和磺胺甲恶唑/甲氧苄啶（耐药率4.95%，15/303）仍保持高度敏感。 结论： 2020—2022年苏州大学附属儿童医院ICU患儿痰培养鲍曼不动杆菌检出率和耐药率明显升高，大肠埃希菌对β-内酰胺酶抑制剂复方制剂耐药也严重。定期监测ICU患儿呼吸道感染病原菌的分布和耐药特征改变对防治多重耐药菌感染尤为重要。.