儿童医院多药耐药菌分布特点及耐药性分析

Characteristics of distribution and drug resistance of multidrug-resistant bacteria in children′s hospital

目的调查儿童医院多药耐药菌(MDROs)群分布及耐药性,为临床合理使用抗菌药物提供依据。方法收集2010年1-12月医院住院患者的各类临床标本,用K-B法进行药敏试验,对分离的多药耐药菌的分布及耐药性进行了回顾性的研究。结果共分离出病原菌1906株,多药耐药菌309株,占16.2%;分离前3位的分别为多药耐药鲍氏不动杆菌(MDRAB)、多药耐药铜绿假单胞菌(MDRPA)、耐甲氧西林金黄色葡萄球菌(MRSA),多药耐药菌分布阳性率占前两位的科室是急救内科和新生儿科,急救内科共94株,新生儿科共90株,MDRPA、MDRAB以痰液检出率最高,构成比为76.8%、96.2%,MRSA以脓液检出率最高,占43.6%,MDRPA对阿米卡星和环丙沙星耐药率最低,分别为23.2%和26.1%,MDRAB对大多数抗菌药物均耐药,耐药率均>50.0%,MRSA对万古霉素耐药率为0,其次对庆大霉素,磺胺甲噁唑/甲氧苄啶和氯霉素耐药率较低,但氯霉素不适于儿童。结论儿童医院多药耐药菌分布范围广,在重点科室所占比率高,对多种抗菌药物耐药,因此要切实加强多药耐药菌的管理。

OBJECTIVE To investigate the distribution and various drug resistance of multidrug-resistant organism（MDRO） in children′s hospital,to provide the basis for clinically reasonable application of antibiotics.METHODS The distribution,composition,and drug resistance of MDRO isolated from various clinical specimens from Jan 2010 to Dec 2010 were retrospectively analyzed,the drug susceptibility testing was performed with K-B method.RESULTS A total of 1906 strains of pathogenic bacteria were isolated,among which there were 309（16.2%） strains of MDRO.The top 3 MDRO isolates were MDROAB,MDROPA,and MRSA,the top 2 departments with the highest positive rates were the emergency medicine department with 94 strains isolated and neonatology department with 90 strains;the detection rates of MDROPA and MDORAB isolated from sputum were the highest,accounting for 76.8% and 96.2%,MRSA isolates were mostly isolated from pus,accounting for 43.6%;the drug resistance rates of MDROPA to amikacin and ciprofloxacin were the lowest with 23.2% and 26.1%,respectively;MDORAB was resistant to most antibiotics with resistance rates above 50.0%;the resistance rate of MRSA to vancomycin was 0 and relatively low to gentamicin,cotrimoxazole,and chloramphenicol,but chloramphenicol was not suitable for children.CONCLUSION Multidrug-resistant organism is widely distributed in children＇s hospital and is with a high percentage in key departments.Therefore it is necessary to strengthen the management of MDRO.