儿科重症监护室病原菌分布及其耐药性

Distribution and antimicrobial resistance of pathogenic bacteria in a pediatric intensive care unit

目的了解儿科重症监护室(pediatric intensive care unit,PICU)病原菌分布及其耐药情况,为预防控制医院感染提供依据,指导临床合理使用抗菌药物。方法对某院2010年6月—2011年5月PICU住院患儿分离的病原菌及其耐药性进行统计分析。结果共检出病原菌245株,以革兰阴性(G-)菌为主,占73.88%;其次为革兰阳性(G+)菌,占22.86%;真菌占3.26%。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎链球菌、金黄色葡萄球菌分别占18.78%、14.29%、11.43%、8.16%、5.31%、4.90%。肺炎克雷伯菌、大肠埃希菌产超广谱β-内酰胺酶(ESBLs)率分别为11.63%和8.85%;耐甲氧西林金黄色葡萄球菌(MRSA)检出率为16.67%。多数G-杆菌对碳青霉烯类抗生素、头孢哌酮/舒巴坦敏感,对其他抗菌药物呈一定程度耐药。鲍曼不动杆菌对碳青霉烯类药物具有较高的耐药性(耐药率达75.00%);肺炎链球菌、金黄色葡萄球菌对头孢曲松、头孢唑林、头孢吡肟保持较高敏感性(耐药率0.00%～7.69%);未发现对万古霉素耐药菌株。结论 PICU住院患儿分离病原菌以G-杆菌为主,多数耐药性较高。细菌分析与耐药性监测对指导临床危重患儿的抗感染治疗,减少耐药菌株具有重要作用。

Objective To investigate the distribution and antimicrobial resistance of pathogenic bacteria in a pediatric intensive care unit （PICU）, and provide reference for preventing and controlling healthcare-associated infection and rational use of antimicrobial agents. Methods Isolation rate and distribution of pathogenic bacteria isolated from PICU patients from June 2010 to May 2011were analyzed statistically. Results A total of 245 pathogenic bacterial strains were isolated, 73. 88%, 22. 86% and 3.26% were gram-negative bacteria, gram positive bacteria and fungi, respectively. The isolation rate of Klebsiella pneumoniae , Escherichia coli , Pseudomonas aeruginosa , Acin- etobacter baurnannii, Streptococcus pneumoniae and Staphylococcus aureus was 18. 78%, 14. 29%, 11. 43%, 8. 16%, 5.31% and 4. 90%, respectively. The percentage of extended-spectrum β-1actamase-producing Klebsiella pneumoniae and Escherichia coli was 11. 63% and 8. 85%, respectively; detection rate of methicillin-resistant Staphylococcus aureus was 16. 67%. Most gram-negative bacteria were sensitive to carbapenems and cefoperazone / sulhactam, and relatively resistant to other antimicrobial agents. Acinetobacter baumannii was highly resistant to carbapenems（75. 00%）. Streptococcus pneumoniae and Staphylococcus aureus were highly sensitive to ceftriaxone, cefazolin and cefepime（0. 00% - 7. 69%） ; no bacterial strain was found to be resistant to vancomycin. Conclusion Gram-negative bacteria is the main pathogenic bacteria in PICU patients, most isolates are highly drug-resistant. A- nalysis of pathogenic bacteria and drug-resistance surveillance are of vital importance to guide treatments for critical- ly ill children and reduce drug-resistant bacterial strains.