Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany.
Department of Pediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Int J Antimicrob Agents. 2021 Nov;58(5):106441. doi: 10.1016/j.ijantimicag.2021.106441. Epub 2021 Sep 20.
Data on antimicrobial resistance (AMR) in the paediatric patient population are scarce. This study assessed the AMR rates and phenotype distribution of Gram-negative isolates in paediatric patients in Europe from 2004-2012 and 2013-2018.
Isolates that were collected were stratified by age groups (< 1, 1-5, 6-12, and 13-17 years) and regions (North-Western, Eastern and Southern Europe). Minimal inhibitory concentrations (broth microdilution) were interpreted according to European Committee on Antimicrobial Susceptibility Testing guidelines. Resistance rates and phenotype prevalence were identified for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Haemophilus influenzae.
In the overall paediatric patient population (0-17 years), extended-spectrum beta-lactamase (ESBL) production significantly decreased (from 20.7% to 15.4%, P < 0.0001) in Escherichia coli, whereas it increased for Klebsiella pneumoniae (from 35.0% to 39.2%, P = 0.015). Carbapenem resistance was highest for Acinetobacter baumannii (32.3%) compared with Klebsiella pneumoniae (4.7%) and Pseudomonas aeruginosa (12.4%) in 2013-2018, and rates were significantly increased relative to 2004-2012. There was no change in resistance to beta-lactam antimicrobials for Haemophilus influenzae. The lowest resistance rates for most organism groups were observed in North-Western Europe.
The results revealed a significant increase in Klebsiella pneumoniae isolates with an ESBL and carbapenem-resistance phenotype as well as in carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa from 2004-2012 to 2013-2018. Conversely, a decrease in ESBL E. coli was observed. Continued surveillance and awareness of resistance in these bacteria causing serious infections is crucial for improving treatment quality in paediatric patients.
儿科患者人群中的抗菌药物耐药（AMR）数据稀缺。本研究评估了 2004-2012 年和 2013-2018 年欧洲儿科患者的革兰氏阴性分离株的 AMR 率和表型分布。
收集的分离株按年龄组（<1、1-5、6-12 和 13-17 岁）和地区（北欧、东欧和南欧）分层。肉汤微量稀释法的最小抑菌浓度（MIC）根据欧洲抗菌药物敏感性测试委员会的指南进行解释。鉴定了大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、鲍曼不动杆菌、铜绿假单胞菌和流感嗜血杆菌的耐药率和表型流行率。
在整体儿科患者人群（0-17 岁）中，产超广谱β-内酰胺酶（ESBL）的大肠埃希菌显著减少（从 20.7%降至 15.4%，P<0.0001），而肺炎克雷伯菌的 ESBL 增加（从 35.0%增至 39.2%，P=0.015）。2013-2018 年，鲍曼不动杆菌的碳青霉烯耐药率最高（32.3%），其次是肺炎克雷伯菌（4.7%）和铜绿假单胞菌（12.4%），与 2004-2012 年相比，碳青霉烯耐药率显著增加。流感嗜血杆菌对β-内酰胺类抗菌药物的耐药率没有变化。大多数菌属的最低耐药率出现在北欧。
结果显示，2004-2012 年至 2013-2018 年，产 ESBL 和碳青霉烯耐药表型的肺炎克雷伯菌以及碳青霉烯耐药的鲍曼不动杆菌和铜绿假单胞菌分离株的数量显著增加，而大肠埃希菌的 ESBL 减少。需要继续监测和提高对引起严重感染的这些细菌的耐药性认识，以提高儿科患者的治疗质量。
