2008-2011年儿科医院感染病原菌分布及耐药性分析

Analysis on distribution and drug resistance of common pathogens in pediatric ward froms 2008 to 2011

目的探讨儿科感染常见病原菌分布及其耐药性,为临床合理用药提供依据。方法对2008年1月-2011年12月儿科住院患儿感染的病原菌及耐药进行回顾性分析。结果各部位标本共培养出病原菌3788株,其中呼吸道、血液、尿液、粪便、伤口分泌物、其他标本中细菌构成比分别为54.6%、11.9%、11.3%、8.5%、7.7%和6.0%;革兰阳性菌1515株,占40.0%;革兰阴性菌1962株,占51.8%;真菌311株,占8.2%;前10位的病原菌依次为金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌、白色假丝酵母菌、表皮葡萄球菌、铜绿假单胞菌、阴沟肠杆菌、流感嗜血菌、溶血性葡萄球菌,分别占21.1%、13.4%、9.6%、8.3%、8.0%、6.1%、3.7%、3.5%、3.3%和2.7%;葡萄球菌属对青霉素的耐药率达>93.0%,对红霉素的耐药率在>69.0%,而对其他药物均有不同程度耐药,未发现耐万古霉素葡萄球菌;革兰阴性杆菌对氨苄西林普遍耐药,对哌拉西林/他唑巴坦和头孢哌酮/舒巴坦、喹诺酮类和氨基糖苷类耐药率较低,对亚胺培南和美罗培南对革兰阴性杆菌保持非常高的敏感性。结论革兰阴性杆菌是儿科病房细菌感染最主要的病原菌,儿科病房感染常见致病菌耐药较严重,加强耐药监测,合理使用抗菌药物非常重要。

OBJECTIVE To explore the distribution and drug resistance of common pathogens in pediatric ward and to provide the basis for clinical rational use of drugs. METHODS A retrospective analysis was made for the distri- bution and drug resistance of all the pathogens in the pediatric hospitalized patients from Jan. 2008 to Dec. 2011. RESULTS A total of 3788 strains of pathogens were isolated, among which the constituent ratios of the respiratory tract, blood, urine, stool, wound pus secreta and other specimens were 54. 6 %, 11. 9%, 11. 3%, 8. 5%, 7.7% and 6.0%, respectively. 1515 gram-postive bacteria （40.0%）, 1962 gram-negative bacillus （51.8%）, and 311 fungi （8.2%） were isolated. The top ten pathogens were Staphylococcus aureus （21. 1%） Klebsiella pneu-moniae （13. 4%）, Escherichia coli （9. 6%）, Acinetobacter baurnannii （8. 3%）, Candida albicans （8. 0%）, Staphylococcus epidermidis （6. 1%）, Pseudomonas aeruginosa （ 3. 7 % ）, Enterobacter cloacae （ 3. 5 % ）, Hae-mophilus influenzae （3.3%） and Staphylococcus haemolyticus （2.7%）. The drug resistance rates of Staphylo-cocci against penicillin and erythromycin were more than 93% and 69%, respectively. Staphylococci showed variant resistance rates to other drugs. No strains of vancomycin resistant Staphylococcus were found. Gram-negative bacillus were generally sensitive to ampicillin, but the drug resistance rates to riperacillin/tazobactam, cefoperazone/Sulbactam, quinolones and aminoglycosides were low, whereas the imipenem and meropenem was very highly susceptive to gram-negative bacillus. CONCLUSION Gram-negative bacillus was the most common pathogens in pediatric wards. The drug resistance rate of pathogens has become a serious problem, so great impor-tance should be attached to strengthening the surveillance of drug resistance and rational use of antimicrobial drugs.