2000—2006年郑州地区PICU下呼吸道感染病原菌及其耐药性的变迁

Change of bacterial pathogens and their antimicrobial resistance in lower respiratory tract infection in PICU from 2000 to 2006.

目的了解郑州地区下呼吸道感染患儿病原菌及其药敏变迁情况。方法对郑州大学第三附属医院PICU病房下呼吸道感染住院患儿痰培养阳性标本结果进行回顾性统计分析。按阶段分为1期(2000年1月至2002年12月)、2期(2003年1月至2004年12月)、3期(2005年1月至2005年12月)、4期(2006年1月至2006年12月)。结果(1)分离出细菌1089株,其中革兰阴性(G-)杆菌800株占73.5%,病原菌主要为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、肠杆菌;革兰阳性(G+)球菌185株,占17.0%,主要病原菌为金黄色葡萄球菌和表皮葡萄球菌;真菌104株,占9.6%。(2)4个时期相比G-杆菌比例基本相同,而G+球菌有所减少,真菌明显增加。(3)药敏试验结果提示主要G-杆菌对常用抗G-杆菌抗生素耐药性逐渐增加,仅对亚安培南、头孢哌酮/舒巴坦、头孢吡肟较敏感。结论近7年郑州大学第三附属医院儿科PICU下呼吸道感染病原菌以G-杆菌为主,G+球菌逐渐减少,真菌逐渐增加。主要病原菌对部分抗菌药物的耐药率有逐渐增高的趋势,临床应合理应用抗生素,以延缓细菌耐药性的产生。

Abstract Objective To study the change of distribution and antibiotics susceptibility of pathogenic bacteria isolated from inpatients with lower respiratory tract infection in PICU during 2000 - 2006. Methods Distribution and resistance of pathogens were analyzed in 1089 culture positive samples in recent 7 years. The results were divided into four groups ： the firstr group（2000. 1 -2002. 12） ,the second group（2003.1 -2004. 12） ,the third group（2005. 1 -2005. 12） and the foutb group l2006. 1 -2006. 12 ）. The strains were identified by VITEK-AMS and antibiotics susceptibility were tested by K-B method. The results were interpreted according to NCCLS. Results In all 1089 pathogens, 800 strains were gram- negative bacilli （73.5%） , and E Coli, Pseudomonasaeruginosa, KlebsieUa pneumonia and Enteric bacilli were most common gram-negative bacillis ; 185 strains were gram-positive bacilli（ 17.0% ） , and Staphylococcus aureus were major gram- positive bacillis ; 104 strains were fungi （ 9. 6% ）. The proportion of gram-positive bacillis in the four groups was about the same. The rates of resistance of common gram-negative bacillis to most antibotics increased gradually. Most strains of gram-negative bacilli were susceptible to Imipenem and cebfoperazone-sulbactam. Conclusion Gram-negative bacilli are still the leading pathogens in lower respiratory tract infection in our PICU during the past 7 years, while gram-positive bacilli decrease gradually, and fungi increase. Antibiotic resistance becomes more prevalent in some major pathogens. Rational use of antibiotics is important for the containment of bacterial resistance.