2012 年至 2021 年中国新生儿抗菌药物敏感性趋势：一项多中心研究。
Trends in the antimicrobial susceptibility among Chinese neonates from 2012 to 2021: a multicenter study.
机构信息
Department of Pediatrics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.
Department of Neonatology, Jiaxing University Affiliated Women and Children Hospital, 2468 Zhonghuan East Road, Nanhu District, Jiaxing, 314000, China.
出版信息
Antimicrob Resist Infect Control. 2024 Jul 30;13(1):83. doi: 10.1186/s13756-024-01440-2.
BACKGROUND
Antibiotic resistance is a serious global public health issue. However, there are few reports on trends in antimicrobial susceptibility in Chinese neonates, and most of the existing evidence has been derived from adult studies. We aimed to assess the trends in antimicrobial susceptibility of common pathogens in full-term neonates with invasive bacterial infections (IBIs) in China.
METHODS
This cross-sectional survey study analyzed the antimicrobial susceptibility in Chinese neonates with IBIs from 17 hospitals, spanning from January 2012 to December 2021. Joinpoint regression model was applied to illustrate the trends and calculate the average annual percentage change (AAPC). Using Mantel-Haenszel linear-by-linear association chi-square test, we further compared the antibiotic minimum inhibitory concentrations (MICs) by pathogens between 2019 and 2021 to provide precise estimates of changes.
RESULTS
The proportion of Escherichia coli with extended-spectrum-beta-lactamase-negative strains increased from 0.0 to 88.5% (AAPC = 62.4%, 95% confidence interval (CI): 44.3%, 82.9%), with two breakpoints in 2014 and 2018 (p-trend < 0.001). The susceptibility of group B Streptococcus (GBS) to erythromycin and clindamycin increased by 66.7% and 42.8%, respectively (AAPC = 55.2%, 95% CI: 23.2%, 95.5%, p-trend = 0.002; AAPC = 54.8%, 95% CI: 9.6%, 118.6%, p-trend < 0.001), as did Staphylococcus aureus to penicillin (AAPC = 56.2%; 95% CI: 34.8%, 81.0%, p-trend < 0.001). However, the susceptibility of Enterococcus spp. to ampicillin declined from 100.0 to 25.0% (AAPC = - 11.7%, 95% CI: - 15.2%, - 8.1%, p-trend < 0.001), and no significant improvement was observed in the antibiotic susceptibility of Escherichia coli to ampicillin, gentamicin, and cephalosporin. Additionally, the proportion of GBS/Staphylococcus aureus with relatively low MIC values for relevant antibiotics also increased in 2021 compared to 2019.
CONCLUSIONS
Antimicrobial susceptibility of the most prevalent pathogens in full-term neonates seemed to have improved or remained stable over the last decade in China, implying the effectiveness of policies and practice of antibiotic stewardship had gradually emerged.
背景
抗生素耐药性是一个严重的全球公共卫生问题。然而，中国新生儿抗菌药物敏感性趋势的报道较少，现有的大多数证据来自成人研究。本研究旨在评估中国足月新生儿侵袭性细菌感染（IBI）常见病原体的抗菌药物敏感性趋势。
方法
本横断面研究分析了 2012 年 1 月至 2021 年 12 月期间 17 家医院的 IBI 中国新生儿的抗菌药物敏感性。采用 Joinpoint 回归模型来阐明趋势并计算平均年变化百分比（AAPC）。通过病原体比较 2019 年和 2021 年的抗生素最小抑菌浓度（MIC），采用 Mantel-Haenszel 线性-线性关联卡方检验进一步提供变化的精确估计。
结果
产 ESBL 阴性大肠埃希菌的比例从 0.0%增加到 88.5%（AAPC=62.4%，95%置信区间（CI）：44.3%，82.9%），2014 年和 2018 年出现两个转折点（趋势 p<0.001）。B 群链球菌（GBS）对红霉素和克林霉素的敏感性分别增加了 66.7%和 42.8%（AAPC=55.2%，95%CI：23.2%，95.5%，趋势 p=0.002；AAPC=54.8%，95%CI：9.6%，118.6%，趋势 p<0.001），金黄色葡萄球菌对青霉素的敏感性也增加了 56.2%（95%CI：34.8%，81.0%，趋势 p<0.001）。然而，肠球菌属对氨苄西林的敏感性从 100.0%下降到 25.0%（AAPC=-11.7%，95%CI：-15.2%，-8.1%，趋势 p<0.001），且氨苄西林、庆大霉素和头孢菌素对大肠埃希菌的抗菌药物敏感性未见明显改善。此外，与相关抗生素 MIC 值较低的 GBS/金黄色葡萄球菌的比例在 2021 年也高于 2019 年。
结论
过去十年，中国足月新生儿最常见病原体的抗菌药物敏感性似乎有所改善或保持稳定，表明抗生素管理政策和实践的有效性逐渐显现。
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