儿科重症监护病房脓毒血症临床及病原学分析

Analysis of the Clinical Characters and of Pathogenic Bacteria Isolated from Childhood Sepsis of PICU

目的:探讨儿科重症监护室(PICU)脓毒血症血培养病原菌的分布特点及其耐药情况,为临床诊疗提供参考。方法:对苏州大学附属儿童医院2008年6月至2011年6月PICU送检的脓毒血症血液标本所分离病原菌的分布及药敏结果进行回顾性分析。结果:共检出45株病原菌,其中革兰阳性(G+)菌29株(64.4%)、革兰阴性菌(G-)15株(33.3%)、真菌1株(2.2%)。前3位的病原菌依次为表皮葡萄球菌(22.2%)、肺炎链球菌(17.8%)、铜绿假单胞菌(17.8%)。G+球菌对儿科常用的β-内酰胺类药物多数耐药,而对万古霉素、复方磺胺甲唑敏感性较高;G-杆菌对第三代头孢菌素高度耐药,而对亚胺培南、环丙沙星、左氧氟沙星敏感性较高。结论:表皮葡萄球菌、肺炎链球菌、铜绿假单胞菌等条件致病菌已成为PICU脓毒血症的主要致病菌,且对常用的多数β-内酰胺类药物耐药。铜绿假单胞菌所致脓毒血症病死率较高,且对多数药物耐药明显。前期经验性抗生素治疗,后期根据药敏结果合理应用抗菌药物是有效控制感染、降低病死率、改善预后的重要手段。

Objective： To investigate the clinical characters and pathogenic bacteria isolated from severe sepsis of PICU, and to provide essential information regarding the selection of antibiotic therapy for septicaemia. Methods： All the blood samples were isolated from patients in Suzhou Children＇s Hospital between June 2008 and June 2011. Pathogenic bacteria and drug sensitivity tests were retrospective analyzed. Results： Totally 45 strains of bacteria were isolated. 29 strains of gram positive bacteria were isolated and accounted for 64.4%. Gram negative bacteria and fungi accounted for 33.3% and 2.2% respectively. The top three places in the bacterium of the disease were staphylococcus epidermidis （ 22. 2% ） , streptococcus pneumoniae （ 17. 8% ） , and pseudomonas aeruginosa （17.8%）. G＋ cocci were resistant to most of the beta-lactam drugs, and were sensitive to vancomycin and compound sulfamethoxazole; G- coli were highly resistant to the three generation cephalosporins, had good sensitivities to imipenem, ciprofloxacin and levofloxacin. Conclusions： Opportunistic pathogens such as Staphylococcus epidermidis, Streptococcus pneumoniae, and Pseudomonas aeruginosa have become the main pathogens of PICU sepsis, have high resistances to most of the beta-lactam drugs. Sepsis caused by Pseudomonas aeruginosa has high mortality rate, Pseudomonas aeruginosa are obviously resistant to the majority of drugs. Early empiric antibiotic treatment and reasonable application of antibacterial drug according to antimicrobial susceptibility test results are an important means to effectively control infection, reduce mortality and improve prognosis.