凉山地区小儿血培养检出菌及药物敏感性分析

Hemoculture Detected Bacteria of Children and Antimicrobial Susceptibility Analysis in Liangshan Region

目的:了解本地区小儿败血症的病原菌种类、不同病原菌在各年龄段的分布情况及主要病原菌药物敏感状况,为指导临床诊断及合理使用抗生素提供依据。方法:对本院儿科近3年经血培养分离出的310株阳性菌株的构成比及对抗生素的药物敏感状况进行回顾性分析。结果:310株检出菌中G+菌201株占64.8%;G-杆菌106株占34.2%;前5位病原菌依次为凝固酶阴性葡萄球菌(CNS)、沙门菌、大肠埃希菌、金黄色葡萄球菌(简称金葡菌)、链球菌属,分别占40.97%、21.61%、6.45%、4.51%、4.19%;新生儿败血症病原菌以CNS为主(101株),其次为大肠埃希菌、肠球菌、克雷伯氏菌;6个月内小婴儿败血症致病菌与新生儿近似;婴幼儿各种细菌败血症均有发生;学龄前及学龄期儿童败血症病原菌依次为沙门菌、链球菌、金葡菌;药敏结果显示,大多数G+菌对青霉素、红霉素、苯唑西林、氨苄西林、头孢唑啉、头孢他啶、复方新诺明、庆大霉素耐药率超过60%;对万古霉素、利福平、阿米卡星、头孢西丁、喹诺酮类敏感。G-杆菌中沙门菌对亚胺培南、氨曲南、三代头孢菌素、酶抑制剂复方制剂、喹诺酮类、复方新诺明保持高度敏感;大肠埃希菌多重耐药,对氨苄西林、哌拉西林、复方新诺明耐药率超过80%,对氨曲南、环丙沙星、庆大霉素、妥布霉素、头孢吡肟、头孢噻肟耐药率超过50%;其他G-杆菌大多数对亚胺培南、呋南妥因、阿米卡星、奎诺酮类、头孢西丁敏感,酶抑制复合制剂的敏感率明显提高。结论:(1)CNS是新生儿及小婴儿败血症的主要病原菌,低毒力条件致病菌在该阶段小儿中感染率高;沙门菌是本地区近三年学龄期儿童败血症的主要病原菌,其感染呈逐年下降趋势。(2)不同病原菌的药敏状况差异很大,应高度重视感染病例的病原学检查,以利于制定临床抗感染方案,合理使用抗生素。(3)万古霉素、利福平、亚胺培南、氨曲南、第3代头孢菌素、阿米卡星及喹诺酮类目前仍为敏感抗生素。

Objective： To understand the pathogenic bacteria species of septicaemia in local children,the distribution of different pathogenic bacteria in different age,and the antimicrobial susceptibility state of the main pathogenic bacteria,so as to provide a basis for the guidance of clinical diagnosis and rational use of antibiotics.Methods： The constituent ratio and antibiotic antimicrobial susceptibility state of 310 positive strains through hemoculture abstraction in paediatrics of our hospital for the recent 3 years were performed with retrospective analysis.Results： In the 310 strains of detection bacteria,there were 201 strains of G＋ bacteria which accounted for 64.8%;there were 106 strains of G-bacteria which accounted for 34.2%;the leading 5 pathogenic bacteria were coagulase negative staphylococcus（CNS）,saimonella,escherichia coli,staphylococcus aureus,streptococcus in order,which accounted for 40.97%,21.61%,6.45%,4.51%,4.19% respectively;CNS（101 strains） was the main pathogenic bacteria for neonatal septicemia,and the next were escherichia coli,enterococcus and klebsiella;the pathogenic bacteria for septicaemia of little infant aged 6 months was similar to newborn infant;all kinds of bacterial septicemia were found in infant and children;the septicaemia pathogenic bacteria of pre-school age and school age children were saimonella,chain coccus,staphylococcus aureus in order;Antimicrobial susceptibility test results showed that the drug-fast rate of most G＋ bacteria for penicillin,erythrocin,oxacillin,ampicillin,cefazolin,ceftazidime,SMZ-TMP,cidomycin were more that 60%,which were also sensitive to vancomycin,rifampin,amikacin,cefoxitin and quinolones.In the G-bacteria,saimonella kept high sensitivity to imipenem,aztreonam,third-generation cephalosporin,enzyme inhibitor compound preparation,quinolones and SMZ-TMP;escherichia coli had multi-drug resistant,and its drug fast-rate for ampicillin,piperacillin and SMZ-TMP was more than 80%,while its drug-fast rate for aztreonam,ciprofloxacin,cidomycin,tobramycine,cefepime and cefotaxim were more than 50%;most other G-bacteria were sensitive to imipenem,nitrofurantoin,amikacin,quinolones and cefoxitin,and the sensitivity of enzyme inhibitor compound preparation was significantly increased.Conclusion：（1） CNS is the major pathogenic bacteria for the septicaemia of newborn infant and little infant,and in this group of children,the infection rate of conditional pathogenic bacteria with low toxicity is high;saimonella is the major pathogenic bacteria for the septicaemia of local school age children in recent 3 years,and its infection has a descendent trend year by year.（2） Different pathogenic bacteria have different antimicrobial susceptibility state,and the aetiology detection of infected cases should be given great importance so as to facilitate the design of clinical anti-infection program and the rational use of antibiotics.（3） At present,vancomycin,rifampicin,imipenem,aztreonam,third-generation cephalosporin,amikacin and quinolones are still sensitive antibiotics.