哈尔滨地区儿科病房感染常见革兰阴性菌及其耐药性分析

Analysis on distribution and drug resistance of gram-negative bacteria in pediatric wards in Harbin

目的:分析哈尔滨地区儿科病房2005年9月至2006年3月间临床分离革兰阴性杆菌分布及其耐药性,为儿科合理使用抗生素提供依据。方法:应用API20E微生物鉴定系统对临床分离菌株进行鉴定,RAPD法排除重复菌株;K-B纸片扩散法对12种抗菌药物进行敏感性测定。结果:儿科病房分离310株革兰阴性杆菌中,以克雷伯菌属(49.1%)多见,肠杆菌属(14.1%)、大肠埃希菌(10.3%)、不动杆菌属(6.7%)和沙雷菌属(5.2%)等构成比低。粪便、痰、脓汁、血液标本中细菌构成比分别为56.4%、25.4%、7.7%和5.1%。药物敏感性实验显示,儿科常见革兰阴性菌对头孢唑啉和头孢呋辛敏感性较差,对头孢唑啉耐药率平均达85.0%,而亚胺培南、头孢西丁、β-内酰胺加酶抑制剂、头孢哌酮、拉氧头孢和阿米卡星的抗菌作用较强;尿液标本分离菌对二代头孢菌素、三代头孢菌素、头霉素和喹诺酮类耐药率较其他部位分离菌高。结论:哈市儿科病房分离的革兰阴性菌中以克雷伯菌属为主,细菌对不同抗生素表现为较高的耐药性,在治疗中应该考虑细菌的耐药特点与感染类型等,合理选择抗生素。

Objective：To investigate the distribution and drug - resistance of gram - negative bacteria in pediatric wards in Harbin. Methods： Bacteria were identified by API20E identification system. Repeated strains were eliminated with random amplification of polymorphic DNA（RAPD）. Susceptibility to 12 antimicrobial agents and combinations of agents was determined by the standard disk diffusion method. Resuits：Klebsiella was the most frequent pathogen in 310 strains. Enterobacter （ 14. 1% ）, Escherichia coli（ 10. 3% ） ,Acinetobacter（6. 7% ） and Serratia（ 5. 2% ） had lower isolation rate. The isolation rate from stool,sputum, pus and blood was 56. 4% ,25.4% ,7.7% and 5.1% ,respectively. The drug sensitivity test showed that the common gram - negative bacteria in pediatrics were less sensitive to cephazoline and cefuroxime with the resistance rate of 85% in average. They were more sensitive to imipenem, cefoxitin, β - lactam/β - lactamase inhibitor, cefoperazone, latamoxef and amikacin. Isolates derived from urine were more resistant to the first, second generation of cephalosporin, cephamycin and quinolones than those from other sites. Conclusion ：Klebsiella is the most frequently isolated gram -negative bacterium in pediatric wards in Harbin. Resistance to various classes of antibiotics is rather high. The strong suggestion is given to clinical practice in rational use of antibiotics based on the drug susceptibility and the type of infection, especially in pediatrics.