广州儿童医院重症监护病房感染病原菌的分布及耐药性分析

Analysis of distribution and antibiotic resistance of pathogenic bacteria in PICU of Guangzhou Children's Hospital.

目的探讨儿科重症监护病房（PICU）感染病原菌的分布及耐药情况，为临床合理选用抗菌药提供参考。方法对广州市儿童医院PICU病房2003年11月-2005年10月各类感染标本所分离的病原菌的分布及耐药性进行回顾性分析。结果共检出295株病原菌，其中革兰阴性杆菌213株（72．2％），主要为铜绿假单胞菌、不动杆菌等非发酵菌；革兰阳性球菌58株（19．7％），主要为葡萄球菌；真菌24株（8．1％）。药敏结果提示铜绿假单胞菌及不动杆菌对亚胺培南、头孢哌酮／舒巴坦、环丙沙星及阿米卡星较为敏感，铜绿假单胞菌对头孢噻肟耐药率较高，而不动杆菌对头孢哌酮、氨曲南、庆大霉素耐药严藿。肠杆菌科细菌对氨苄西林、氨苄西林／舒巴坦、哌拉西林及多种头孢菌素耐药率较高而对亚胺培南、头孢哌酮／舒巴坦、阿米卡星等较敏感。葡萄球菌对青霉素、红霉素严重耐药，但对万古霉素、替考拉宁及阿米卡星敏感性高。结论铜绿假单胞菌等非发酵菌已成为PICU病房感染的主要病原菌。根据病原菌种类及药敏结果合理应用抗菌药是有效控制危重病患儿感染和减少耐药菌株产生的重要手段。

Objective To investigate the distribution and antibiotic resistance of pathogenic bacteria in PICU and to provide evidence for use of antibiotics rationally. Method All the pathogenic bacteria isolated from pediatric intensive care unit of our hospital from Nov. 2003 to Oct. 2005 were retrospectively analyzed. Results Gram negative bacteria was the most prevalent strains and accounted for 72.2% in 295 strains isolated. Gram positive bacteria and fungi accounted for 19.7% and 8. 1% respectively. Pseudomonas aeruginosa and Acinetobacter were the main strains of Gram negative bacteria and coagulase - negative staphylococcus was the main strains of Gram positive bacteria. The antibiotic resistance of Enterobacteriaceae to ampicillin, ampicillin/sulbactam, piperacillin and cephalosporin were higher, but to imipenem, cefoperazone/sulbactam and amikacin were lower. Acinetobacter was resistant to most of monitored antibiotics, except for imipenem, cefoperazone/sulbactam. Pseudomonas aeruginosa was resistant to Cefotaxime but susceptible to the others. Staphylococcus was highly resistant to penicillin and erythromycin but susceptible to vancomycin, teicoplanin and amikacin. Conclusions Pseudomonas aeruginosa was the most prevalent strains isolated in PICU. It was important for clinic using antibiotics rationally according to drug sensitivity test.