儿童与成人患者标本中主要革兰阴性肠杆菌的耐药率比较

Comparison of Gram-negative Enterobacteriaceae drug-resistance rate between children and adults

目的:由于儿童与成人患者标本中分离的革兰阴性肠杆菌的耐药特点常表现不同,因此本文对儿童与成人患者标本进行分离培养,并对主要革兰阴性肠杆菌分离株进行药敏试验,了解其在儿童与成人患者中的耐药率差异,以便指导临床合理使用抗菌药物。方法:收集2009年1月-2011年6月分离自儿童与成人患者标本的革兰阴性肠杆菌,采用VITEK-32全自动微生物鉴定仪进行细菌鉴定,药敏测定采用K-B法,并比较儿童与成人患者标本所检出的主要革兰阴性肠杆菌对抗菌药物的耐药率差异。结果:儿童、成人患者标本检出革兰阴性肠杆菌分别为479株和1056株,前3位革兰阴性肠杆菌分离株为大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌。儿童患者标本大肠埃希菌、肺炎克雷伯菌分离株的ESBLs检出率明显高于成人标本(均P<0.05),儿童与成人患者标本的阴沟肠杆菌AmpC检出率有明显差异(均P<0.05);儿童、成人患者标本的大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌分离株对多种抗生素的耐药率不同,差异均有显著性(均P<0.05)。结论:儿童、成人患者标本中分离的主要革兰阴性肠杆菌分离株对同一抗菌药物耐药率不同,建议临床在抗感染治疗时,应根据药敏结果,合理使用抗菌药物。

Objective：Based on isolation culture and drug sensitivity test of Gram-negative Enterbacteriaceae,to understand the drug-resistance rate difference between adults and children,so as to guide the rational use of antibacterial agents in clinic.Methods： Gram-negative Enterbacteriaceae were isolated from specimens of children and adult patients from January 2009 to June 2011,bacterial identification was performed by VITEK-32 automatic microbiological analyzer,and drug sensitivity test was done with Kirby-Bauer method,then the drug-resistance rates of isolates from children and adults to antimicrobial agents were compared.Results： The Gram-negative Enterbacteriaceae were found 479 strains in children and 1056 strains in adults,Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae ranked the top three.The ESBLs of Escherichia coli and Klebsiella pneumoniae had higher positive rate in specimens of children than those in adults（P0.05）.The AmpC positive rate of Enterobacter cloacae had significant difference between children and adults（P0.05）.The Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae from specimens of children and adults exhibited various resistance to different antibiotics,with obvious difference（P0.05）.Conclusion： The main Gram-negative Enterbacteriaceae isolates showed diverse drug resistance to the same antibacterial agents,so rational antibacterial agents use should be in line with the drug sensitivity test in clinical anti-infection treatment.