深圳地区儿童血培养的病原菌分布及耐药性研究

Distribution and drug resistance of pathogenic bacteria from cultured blood of children in Shenzhen

目的探讨深圳地区儿童血培养的病原菌分布特点及其耐药情况，为临床诊疗提供参考。方法血培养采用Baet／AIERT 3D全自动检测系统，并以VITEK32微生物分析系统进行细菌鉴定及药敏分析。结果血培养阳性率为7．3％，共检出192株病原菌，其中革兰阳性菌144株，占75％，革兰阴性菌46株，占24％，真菌2株，占1％，分离率前五位的病原菌依次为凝固酶阴性葡萄球菌（CNS）121株（63.0％），大肠埃希菌12株（6.3％），肺炎克雷伯菌10株（5．2％），伤寒沙门菌8株（4，1％），铜绿假单胞菌7株（3．6％）。CNS对青霉素、氨苄西林／舒巴坦、红霉素耐药率均超过80％，但对万古霉素、莫西沙星、利奈唑烷、呋喃妥因敏感；MRCNS检出率为83％，革兰阴性杆菌对氨苄西林，复方新诺明、头孢吡肟的耐药率为50％-90％，但对亚胺培南、左旋氧氟沙星、哌拉西林／他唑巴坦、呋喃妥因、丁胺卡那较敏感。结论发现凝固酶阴性葡萄球菌是深圳地区儿童败血症主要的病原菌，了解病原菌分布特点及其耐药情况对临床合理选用抗生素具有重要意义。

Objective To investigate the distribution and antibiotic resistance of pathogenic bacteria isolated from blood samples of children in shenzhen district and to provide essential information regarding the selection of antibiotic therapy for septicaemia. Methods All the blood sample were isolated from children in Shenzhen Children＇ s Hospital between Janunary 2007 and March 2008, And were cultured with Bact/AIERT 3D automatic system, analyzed with VITEK32 system. Results 192 strains of bacteria were isolated, 144 is gram positive bacteria trains（ accounted for 75% ） ,46 is gram negative bacteria trains（ accounted for 24% ） ,2 is fungi strains （ accounted for 1% ）. The commonest strain is coagulase negative staphylococ- cus （ 121 strains）, followed by Escherichia coli （ 12 strains）, Klebsiella spp （ 10 strains）, typhoid bacilli （ 8 strains） and pseudomona aeruginose（7 strains）. The antibiotic resistance rate of coagulase negative staphylococcus to penicillin, ampicillin/sulbactam,erythromycin are all more than 80%, but sensitive to vancomycin, moxifloxacon, linezoid, nitrofurantoin. The antibiotic resistance rate of gram positive bacteria trains to ampicillin, compound sulfamethoxazole, cefepime are between 50% and 80%, but sensitive to imipenem, levofloxacin, piperacillin/tazobactam, nitrofurantoin, amikacin. Conclusion Coagulase negative staphylococcus was the commonest strains of children scpticacmia in Shcnzhcn district, It was important for reasonable use of antibiotics to know distribution and antibiotic resistance of pathogens.