Objective: To investigate the prevalence and resistance changes of carbapenem-resistant Enterobacteriaceae (CRE) strains isolated from children patients of Chinese Bacterial Resistance Surveillance Network (CHINET) from 2005 to 2017. Methods: Antimicrobial susceptibility testing was carried out by disk diffusion method (KB method) and automated systems. Results were analyzed according to the Clinical and Laboratory Standards Institute (CLSI) 2017 edition standards. Results: Among the 4 481 CRE clinical strains, the overall prevalence of CRE in children was 6.4%, including 8.8% in neonatal period, 7.3% in infancy, 3.8% in early childhood, 4.0% in preschool, 4.7% at school age and 7.4% of puberty. The CRE prevalence of citrobacter spp. remained stable in 2005-2017, whereas other bacteria showed an upward trend, which was higher than that of the adult group (P<0.01). Among the 4 481 CRE strains, there were 2 905 strains of Klebsiella spp. (64.8%), 813 strains of Escherichia coli (18.1%), 549 strains of Enterobacter spp.(12.3%), and 65 strains of Citrobacter spp.(1.5%). Among the 4 481 CRE strains, 20.7%, 13.3%, and 11.8% were from the intensive care unit (ICU), neonatal department and internal medicine wards, respectively. Specimens were distributed as respiratory (42.8%), urine (26.3%), and blood (14.9%). The results of antimicrobial susceptibility testing exhibited that the CRE strains were highly resistant to most commonly used antimicrobial agents in clinical practice, such as imipenem, meropenem and ertapenem, as well as penicillins and cephalosporins, etc. Conclusion: The prevalence of CRE strains in children is increasing year by year, and their antimicrobial resistance to common antibacterial agents in clinical practice is extremely serious, to which serious attention needs to be paid. According to the results of antimicrobial susceptibility testings, the antibacterial agents should be rationally selected to effectively control the spread of CRE.
目的： 了解2005—2017年中国细菌耐药监测网（CHINET）儿童人群中碳青霉烯类耐药肠杆菌科细菌（CRE）的检出率和耐药率变迁。 方法： 采用纸片扩散法（KB法）和自动化药敏测定仪对CRE菌株进行药敏试验，并采用美国临床和实验室标准化协会2017年版标准判断结果。 结果： 共收集4 481株临床分离CRE菌株，其在儿童中的总检出率为6.4%，其中新生儿期的检出率为8.8%，婴儿期为7.3%，幼儿期为3.8%，学龄前期为4.0%，学龄期为4.7%，青春期为7.4%。2005 — 2017年儿童临床分离CRE菌株除枸橼酸杆菌属检出率稳定外，其余种属的CRE菌株检出率均呈上升趋势，接近甚至高于同期成人CRE菌株的检出率。4 481株CRE菌株主要为克雷伯菌属（2 905株，64.8%）、大肠埃希菌（813株，18.1%）、肠杆菌属（549株，12.3%）和枸橼酸杆菌属（65株，1.5%）等种属；主要分布在重症监护室（20.7%）、新生儿科（13.3%）、内科（11.8%）等病房；主要分离自呼吸道标本（42.8%）、尿液标本（26.3%）和血标本（14.9%）等临床标本。药敏试验结果显示，CRE菌株对亚胺培南、美罗培南和厄他培南3种碳青霉烯类药物以及受试的青霉素类、第一代、第二代、第三代和第四代头孢菌素等大多临床常用抗菌药物呈高度耐药。 结论： 儿童CRE菌株检出率逐年上升，且对临床常用抗菌药物的耐药情况极为严重，需引起高度重视；临床需根据药敏试验结果，合理选用抗菌药，有效控制CRE菌株的扩散和传播。.
Keywords: Carbepenem-resistant; Child; Drug resistancel, bacterial; Enterobacteriaceae.