儿科常见革兰阴性杆菌的临床分布特征和对碳青霉烯类等抗生素的敏感性

Study of distribution characters of common Gram-negative bacilli isolated from pediatrics department and their drug sensitivities to carbapenem and other antibiotics

目的:了解儿科常见革兰阴性杆菌在各类送检标本和病区的检出和分布,分析比较亚胺培南、美罗培南及其他抗生素对这些革兰阴性杆菌的体外敏感性,为临床合理用药提供依据。方法:对2009年9月-2010年12月期间我院患儿感染性标本分离的革兰阴性杆菌采用VITEK60全自动微生物分析仪结合CNI卡或常规方法鉴定,用GNS卡或K-B法做药敏试验,用GNS卡检测大肠埃希茵和肺炎克雷伯茵产超广谱β内酰胺酶(ESBLs)的情况,并用WHONET 5.4和SPSS 13.0软件进行分析评价。结果:1 419株非重复分离的革兰阴性杆菌中,大肠埃希茵469株(33.05%),肺炎克雷伯菌465株(32.77%),鲍曼不动杆菌158株(11.13%),铜绿假单胞菌137株(9.65%),阴沟肠杆菌100株(7.05%),产气肠杆菌51株(3.60%)和嗜麦芽窄食单胞菌39株(2.75%)。所有菌株主要分离自痰液标本,分布于监护病区和呼吸科。大肠埃希茵中产ESBLs株占66.30%,肺炎克雷伯菌中产ESBLs株占53.88%。大肠埃希茵、阴沟肠杆菌、产气肠杆菌、肺炎克雷伯茵、铜绿假单胞茵和鲍曼不动杆茵对亚胺培南与关罗培南的敏感率依次为100%vs 99.4%、100%vs 99%、100%vs100%、96.1%vs 98.7%、83.9%vs 85.4%和74.1%vs 74.7%,嗜麦芽窄食单胞茵对它们的敏感率仅为2.6%vs 2.1%。大多数革兰阴性杆菌对头孢哌酮舒巴坦、哌拉西林他唑巴坦、阿米卡星、庆大霉素、左氧氟沙星仍有一定的敏感性,而对氨苄西林和头孢唑啉高度耐药。结论:大肠埃希菌、肺炎克雷伯茵、鲍曼不动杆菌、铜绿假单胞茵占儿科临床检出的革兰阴性杆菌前四位。存在高比例的产ESBLs肺炎克雷伯茵和大肠埃希菌;亚胺培南和美罗培南仍对各种肠杆菌科细菌(无论ESBLs存在与否)高度敏感,而对大多数非发酵菌敏感性尚可。

OBJECTIVE To investigate the distribution characters of common bacilli isolated from children in hospital specimens and wards, and compare their antibiotic sensitivity to carbapenems and other β antibiotics, which will provide guidance for ratinale use of drugs in clinic. METHODS The GNI cards for VITEK60 auto-microbiology analyzer were used for identifying bacilli isolated during September 2009 to December 2010 and GNS cards were used for detecting antibiotic resistance and extended-spectrum β-lactamas（ESBLs）in Escherichia coli, Klebsiella pneumoniae. WHONET 5. 4 and SPSS 13.0 softwares were employed for statistical analysis in the study. RESULTS Of 1 419 non-duplicate Gram-negative bacilli, 469 （33.05%） were Escherichia coli, 465 （32. 77 %） Klebsiella pneumoniae, 158 （ 11.13 %） Acinetobacter Baumannii, 137 （9. 65 %） Pseudomona aeruginosa, 100 （7. 05 % ） Enterobacter cloacae, 51 （3.60 % ） Enterobacter aerogenes and 39 （2. 75 % ） Strenotrophomonas mahophilia. All strains were mainly isolated from sputum and intensive care units. The sensitive rates of Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae, Pseudomona aeruginosa, Acinetobacter Baumannii and Strenotrophomonas mahophilia to imipenem and meropenem were 100% vs 99. 4%, 100% vs 99%, 100% vs 100%, 96. 1% vs 98. 7%, 83. 9% vs 85.4%, 74. 1% vs 74. 7% and 2. 6% vs 2. 1%, respectively. Most of bacilli were relatively sensitive to cefoperazone/sulbactam, piperacillin/tazobactam, amikacin, gentamycin and levofloxacin, while significantly resistant to cefazolin and ampicillin. CONCLUSION Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomona aeruginosa occupy the top four places in isolated bacilli in our hospital. ESBLs-producing Escherichia coli and Klebsiella pneumoniae frequently exist. Most of Enterobacteriaceae isolates are highly sensitive to both imipenem and meropenem regardless of the status of ESBLs, and most of non-fermenting bacteria are relatively sensitive to them.