儿科心脏重症监护病房患儿呼吸道感染病原菌的分布及耐药性研究

The distribution and drug resistance of respiratory tract infection pathogens isolated from patients of pediatric CICU

目的探讨儿科心脏重症监护病房(CICU)呼吸道感染常见病原菌的分布及耐药情况,为临床合理选用抗菌药物提供参考。方法回顾性分析该医疗中心2011年1月至2012年12月1 350例CICU下呼吸道感染患儿痰液标本培养及药敏检测结果。结果 1 350例痰标本中,共培养获得病原菌490株,其中革兰阴性杆菌288株(58.78%),革兰阳性球菌140株(28.57%),真菌62株(12.65%)。革兰阴性杆菌以肺炎克雷伯菌为主(62株,占12.65%),其次为卡他布兰汉菌、铜绿假单胞菌、大肠埃希菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)菌株阳性率分别为73.33%和66.13%。革兰阳性球菌以金黄色葡萄球菌为主(65株,占13.27%),其次为肺炎链球菌。耐甲氧西林金黄色葡萄球菌(MRSA)占24.62%。结论金黄色葡萄球菌、肺炎链球菌、肺炎克雷伯菌为CICU患儿呼吸道感染的主要病原菌,且存在多重耐药菌感染,根据病原菌种类及药敏结果合理应用抗菌药物是有效控制危重病患儿感染和减少耐药菌株产生的重要手段。

Objective To analyze the common respiratory tract infection pathogens distribution and their drug resistance in pediatric cardiac intensive care unit（CICU）,so as to provide reference for clinical rational use of antibiotics.Methods 1 350 cases of sputum specimens from lower respiratory tract infection patients of pediatric CICU in the medical center between January 2011 and December 2012 were cultivated and drug susceptibilities were tested.The results were retrospectively analyzed.Results 490 pathogenic strains were isolated from 1 350 cases of sputum specimens and identified,including Gram negative bacilli 288 strains （58.78%）,Gram positive coccus 140 strains（28.57%）,fungi 62 strains（12.65%,mainly Candida albicans ）.Gram negative bacilli was given priority to with Klebsiella pneumoniae （62 strains,12.65%）,followed by Branhamella catarhalis ,Pseudomonas aeruginosa and Escherichia coli .The rates of extended-spectrum beta-lactamases（ESBLs）-producing strains among Escherichia coli and Klebsiella pneumoniae were 73.33% and 66.13%,respectively.Gram positive coccus was given priority to with Staphylococcus aureus （65 strains,13.27%）,followed by Streptococcus pneumoniae .Methicillin-resistant Staphylococcus aureus （MRSA）accounted for 24.62%.Conclusion Staphylococcus aureus ,Streptococcus pneumoniae and Klebsiella pneumoniae are main pathogens of respiratory tract infection in pediatric CICU.And there is multiple drug-resistant bacteria infection.Rational applicattion of antibiotics according to the test results of isolation and drug susceptibility is an effective way to control the infection of critical children and reduce the emergence of resistant strains.