苏州地区儿童重症监护病房下呼吸道感染病原体分布及药敏分析

Distribution and Antibiotic Resistance of Pathogens Isolated from Children with Lower Respiratory Tract Infection in PICU of Suzhou

目的了解苏州地区危重症儿童下呼吸道感染病原体分布及耐药情况。方法对2009年1月—2012年3月苏州大学附属儿童医院重症监护病房(PICU)下呼吸道感染患儿病原体的分布及耐药性进行分析。结果共计分离出致病菌817株,其中革兰阴性菌642株(占78.58%),革兰阳性菌174株(占21.30%),真菌1株(占0.12%),三者构成比间差异有统计学意义(χ2=538.463,P<0.05)。大肠埃希菌及肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)率分别为78.57%(55/70)和71.74%(66/92),金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)检出率为20.98%(17/81)。革兰阴性菌对氨苄西林/舒巴坦及多数头孢菌素类耐药率较高,革兰阳性菌对青霉素、红霉素、克林霉素耐药率较高。结论革兰阴性菌是苏州地区PICU下呼吸道感染主要病原体,其对常用抗菌药物耐药率较高,临床治疗应根据药敏试验合理使用抗菌药物,有效控制院内感染。

Objective To investigate the distribution and drug resistance of pathogenic bacteria isolated from children with lower respiratory tract infection （LRTI） in pediatric intensive care unit （PICU） of Suzhou. Methods The distribution and drug resistance profile of pathogenic bacteria isolated from LRTI children admitted to the PICU of our hospital between January 2009 and March 2012 were analyzed. Results A total of 817 strains of pathogen were isolated, including 642 （78.58%） strains of Gram - negative bacteria, 174 （21.30%） strains of Gram - positive bacteria, and 1 （0. 12% ） strain of fungi （X2 = 538.463, P 〈0. 05）. The extended spectrum[3- lactamase （ESBLs） producing rates of Escherichia coli and Klebsiella pneu- moniae were 78. 57% （55/70） and 71.74% （66/92）, respectively. The detection rate of Methicillin - resistant Staphylococ- cus aureus （MRSA） in Staphylococcus au＇reus was about 20.98% （ 17/81 ）. Gram - negative bacteria had a high resistance rate for ampicllin sulbactam and most cephalosporins, and low resistance rate for amikacin, piperacillin tazobactamm, cefoperazone sulbactam, SMZ TMP,＂ carbapenems and quinolones. Gram -positive bacteria had a high resistance rate for penicillin, erythro- mycin and clindamycin, and low resistance rate for vancomyein and rifampicin. Conclusion Gram - negative bacteria are the main pathogens of LRTI among children in PICU of Suzhou, and are highly resistant to many kinds of antimicrobial agents. Clini- cal treatment should be selected according to antimicrobial susceptibility test.