湖北地区近5年来儿童感染常见革兰阴性杆菌的分布及耐药性变迁

Changes of pathogens distribution and drug-resistance of gram-negative bacilli in children's infection in recent five years in Hubei region

目的：探讨湖北地区儿童感染常见革兰阴性杆菌的种类分布及耐药性变迁,为临床医师抗感染化疗提供参考依据。方法：对2所大型儿童医院2002年1月-2006年12月5年期间临床分离的革兰阴性杆菌进行统计分析;药敏试验采用纸片扩散法,按照美国临床实验室标准化研究所委员会（CLSI/NCCLS）标准判断药敏结果。结果：5年中分离的革兰阴性杆菌以大肠埃希菌（ECO）和肺炎克雷伯菌（KPN）为主,ECO和KPN产超广谱β-内酰胺酶（ESBLs）率分别达43.79%-70.99%和44.24%-57.04%;2004、2005、2006年流感嗜血杆菌（HI）产β-内酰胺酶率分别为37.04%、50.67%、34.26%。结论：儿童感染常见革兰阴性杆菌的耐药性呈上升趋势,究其原因与儿科抗生素应用的局限性和临床大量使用广谱抗生素密切相关。

Objective：To investigate the changes of pathogens distribution and their drug-resistance of gram-negative bacilli in children＇s infection in Hubei and provide the reference for clinical application of antimicrobial treatment.Method：Isolated gram-negative bacilli in 2 large children＇s hospitals from January 2002 to October 2006 were analyzed statistically.Drug susceptibility tests were performed by K-B methods,and the results were judged analytically according to Clinical and Laboratoy Standard Institute（CLSI/NCCLS）.Result：In recent five years Escherichia coli（ECO） and K.pneumonia（KPN） were the majority of Gram-negative bacilli isolated from patients,and ESBLs producing ECO and ESBLs producing KPN accouted for 43.79%～70.99% and 44.24%～57.04%,respectively.Haemophilus influenzae（HI） producing β-lactamase accounted for 37.04%,50.67% and 34.26% in 2004、2005 and 2006,respectively.Conclusion：In recent five years,drug-resistance of gram-negative bacilli in children infection showed increasing tendency.The reason for such phenomenon could be attributed to the limitation of antibiotics application in pediatrics and overusage of broad spectrum antibiotics.