90例小儿败血症细菌培养与药敏结果分析

Pathogen Distribution and Drug Susceptibility Analysis in 90 Children with Sepsis

目的 探讨小儿败血症病原菌的构成及药物敏感性.方法 回顾性分析2007年2月～2012年2月收治的90例小儿败血症的病原学及抗生素敏感试验结果.按照〈全国临床检验操作规程〉进行细菌培养、分离及鉴定.使用VITEK-32全自动细菌鉴定及药敏分析仪进行药敏测定,手工药敏试验采用世界卫生组织推荐的纸片扩散（K-B）法进行.结果 小儿败血症致病菌中,革兰阳性菌有58株（占64.4%）,其中以表皮葡萄球菌、肺炎链球菌、金黄色葡萄球菌为主;革兰阴性菌共32株（占35.6%）,其中以大肠埃希菌和肺炎克雷伯菌为主.表皮葡萄球菌对青霉素G的耐药率高达100.0%.肺炎链球菌对万古霉素、利奈唑胺、替考拉宁100%敏感,对红霉素和阿奇霉素的耐药率分别为84.2%和73.7%.金黄色葡萄球菌对万古霉素、利奈唑胺、替考拉宁高度敏感（敏感率87.5%～100%）,对青霉素G、第一代头孢几乎全部耐药.大肠埃希菌对氨苄西林部分敏感,对头孢菌素类抗生素具有较高的敏感性.肺炎克雷伯菌对氨苄西林耐药率已达88.9%,对广谱头孢菌素头孢吡肟耐药率已达44.4%.结论 小儿败血症病原菌以革兰阳性菌为主,表皮葡萄球菌是重要病原菌.临床医生应主要留取病原学标本,结合抗菌药物敏感试验结果合理使用抗生素,以减少耐菌株的产生.

Objective To probe into the pathogenic types and the results of drug sensitive test in children with sepsis. Methods The statistical distribution of pathogens isolated from clinical samples from Dec 2007 to Dec 2012. Pathogenic types and the results of drug sensitive test in 90 children with sepsis were analyzed retrospectively. Pathogen eultivation separation and identification were in aecordance with （（The national clinical inspection procedures））. VITEK-32 fulbautomatic pathogen identification and drug sensitive analyzer was applied to test bacteria drug sensitivity. Manual drug sensitive test were proceed by the world health organization recommends the disc diffusion （K-B） method. Results Among the pathogens isolated from pediatric patients with sepsis, there were 58 strains of gram-positive bacteria （64. 4%）, the first three predominant species were staphylococcus epidermidis,streptococcus pneumoniae and staphylococcus aureus;there were 32 strains of gram-negative bacteria （35.6 %） ,Escherichia coli and Klebsiella pneumoniae were the two main pathogens. Staphylococcus epidermidis resistant to penicillin G as high as 100.0 %. The drug resistance rates of Streptococcus pneumoniae to vancomycin,linezolid,teicoplanin were 100%, while the ratesto erythromycin and azithromycin were 84. 20/6o and 73. 7%, respectively. Staphylococcus aureus was still highly sensitive to vancomycin, linezolid, teicoplanin（the drug sensitive rates as 87. 5% 100 % ） while almost all resistant to penicillin G and the first generation cephalosporin. Escherichia coli was still highly sensitive to cephalosporins and partly sensitive to arnpicillin. The drug resistance rates of Klebsiella pneurnoniae to ampicillin and cefepime were 88.9% and 44. 4% respectively. Conclusion Gram-positive bacteria given priority to pathogens causing pediatric sepsis in this region, the main pathogen is staphylococcus epidermidis. Clinician should reasonably use the antibiotics according as the drug sensitive test,result in reducing drug resistance strains.