昆明地区2002～2006年儿童脓毒症病原菌分布及耐药性分析

Analysis of pathogenic distribution and antimicrobial susceptibility in children with septicemia of Kunming region during 2002-2006

目的了解昆明地区近5年来脓毒症患儿病原菌分布及耐药状况。方法对2002年1月～2006年12月昆明市儿童医院脓毒症患儿血培养阳性菌病原菌构成比及耐药性进行统计分析及临床总结。结果20287份血培养标本中检出959株病原菌，检出阳性率4．7％。959株菌株中检出革兰阳性（G^＋）球菌731株，占76．2％，凝固酶阴性葡萄球菌620株，占葡萄球菌的84．8％。革兰阴性（G^-）杆菌228株，占23．8％，其中非发酵菌96株，占G^-杆菌的42．1％。故5年间脓毒症病原菌以凝固酶阴性葡萄球菌为主，肠球菌、非发酵菌有增加趋势。5年间耐药菌逐年增加，G^＋菌对青霉素的耐药率为100％，对红霉素的耐药率为86．6％，未发现万古霉素的耐药株。5年间检出大肠埃希杆菌、肺炎克雷白杆菌共75株，产超广谱B内酰胺酶（ESBLs）31株（41．3％），31株产ESBLs菌对氨苄西林、头孢唑林、头孢噻肟耐药率为100％．对亚胺培南耐药率为0。结论5年间脓毒症的主要病原菌以凝固酶阴性葡萄球菌为主，儿科血培养检出菌对常用抗生素耐药率上升，及时监测病原菌变化及耐药趋势对指导临床用药至关重要。

Objective To investigate pathogenic distribution and antimierobial suscepribility in septic children in the past 5 years. Methods We had reviewed the eases of septic children who had positive blood culture in Kunming Children＇s Hospital from Jan 2001 to Dee 2006. Statistical analysis of pathogenic distribution and antimierobial susceptibility was performed in these eases. Results A total of 959 blood samples for blood culture were obtained in 20 287 patients and the positive ratio was 4.7 %. Seven hundred and thirty-one strains were Gram-positive cocci and the ratio was 76.2 %. Six hundred and twenty strains were coagulasenegative staphylococci, accounting for 84.8 % of Gram-positive cocci. Two hundred and twenty-eight strains were Gram-negative bacilli and the ratio was 23.8 %. 96 Ninety-six non-fermentative bateria were detected. accounting for 42.1% of Gram-negative bacilli. So coagulase- negative staphylococci was the most common strain in septic children in the past 5 years. However. a gradual increase of non-fermentative bacteria was observed during the last 5 years. Antibiotic resistance of every bacterium increased gradually. The resistance percentage of Gram-positive bacilli to penicillin and erythromyein were 100 % and 86.6 %. We found no cocci resistance to vaneomycin. Seventy-five strains were Eseheriehia eoli and ldebsiella pneumonia bacilli, among which 31 strains were detected producing extended-spectrum β-laetamases （ESBLs）. All of ESBLs-produeing strains resisted to ampieillin, eephazolin and eefotaxine. No imipenem-resistant bacilli were found. Conclusion Coagulase-negative staphylococci were the leading pathogen of pediatric septicemia in the past 5 years and the drug resistance increased as time passed. It suggested that more attention should be paid to drug resistance tendency before prescription.