Departments of Pediatrics.
Section of Pediatric Infectious Diseases, Rush Medical College, Rush University Medical Center, Chicago, Illinois.
J Pediatric Infect Dis Soc. 2017 Nov 24;6(4):352-359. doi: 10.1093/jpids/piw064.
Pseudomonas aeruginosa is a common cause of healthcare-associated infection. Multidrug-resistant (MDR) (>3 classes) and carbapenem-resistant (CR) P aeruginosa are significant threats globally. We used a large reference-laboratory database to study the epidemiology of P aeruginosa in children in the United States.
Antimicrobial susceptibility data from the Surveillance Network were used to phenotypically identify MDR and CR P aeruginosa isolates in children aged 1 to 17 years between January 1999 and July 2012. Logistic regression analysis was used to calculate trends in the prevalence of MDR and CR P aeruginosa. Isolates from infants (<1 year old) and patients with cystic fibrosis were excluded.
Among the isolates tested, the crude proportion of MDR P aeruginosa increased from 15.4% in 1999 to 26% in 2012, and the proportion of CR P aeruginosa increased from 9.4% in 1999 to 20% in 2012. The proportion of both MDR and CR P aeruginosa increased each year by 4% (odds ratio [OR], 1.04 [95% confidence interval (CI), 1.03-1.04] and 1.04 [95% CI, 1.04-1.05], respectively). In multivariable analysis, both MDR and CR P aeruginosa were more common in the intensive care setting, among children aged 13 to 17 years, in respiratory specimens, and in the West North Central region. In addition, resistance to other antibiotic classes (aminoglycosides, fluoroquinolones, cephalosporins, and piperacillin-tazobactam) often used to treat P aeruginosa increased.
Rates of MDR and CR P aeruginosa infection in children are rising nationally. Aggressive prevention strategies, including instituting antimicrobial stewardship programs in pediatric settings, are essential for combating antimicrobial resistance.
铜绿假单胞菌是一种常见的医源性感染病原体。多药耐药（MDR）（>3 类）和耐碳青霉烯铜绿假单胞菌（CR）是全球的重大威胁。我们使用大型参考实验室数据库研究了美国儿童中铜绿假单胞菌的流行病学。
使用监测网络的抗生素药敏数据，对 1999 年 1 月至 2012 年 7 月期间年龄在 1 至 17 岁的儿童中 MDR 和 CR 铜绿假单胞菌分离株进行表型鉴定。使用逻辑回归分析计算 MDR 和 CR 铜绿假单胞菌流行率的趋势。排除婴儿（<1 岁）和囊性纤维化患者的分离株。
在所检测的分离株中，MDR 铜绿假单胞菌的粗比例从 1999 年的 15.4%增加到 2012 年的 26%，CR 铜绿假单胞菌的比例从 1999 年的 9.4%增加到 2012 年的 20%。MDR 和 CR 铜绿假单胞菌的比例每年分别增加 4%（比值比 [OR]，1.04[95%置信区间（CI），1.03-1.04]和 1.04[95%CI，1.04-1.05]）。在多变量分析中，MDR 和 CR 铜绿假单胞菌在重症监护病房、13 至 17 岁儿童、呼吸道标本和中西部北部地区更为常见。此外，对其他抗生素类别的耐药性（氨基糖苷类、氟喹诺酮类、头孢菌素类和哌拉西林-他唑巴坦）经常用于治疗铜绿假单胞菌，也在增加。
全国儿童中 MDR 和 CR 铜绿假单胞菌感染率正在上升。积极的预防策略，包括在儿科环境中实施抗菌药物管理计划，对于对抗抗菌药物耐药性至关重要。
