儿童重症监护病房感染病原菌分布及其耐药性分析

Distribution and Antibacterial Resistance of Pathogens in Pediatric Intensive Care Unit

目的 分析大连市儿童医院儿童重症监护病房感染患儿的病原菌分布及其耐药性,为临床合理应用抗菌药物提供借鉴.方法 选取2015年1月—2016年12月在大连市儿童医院儿童重症监护病房住院的感染患儿,对患儿分离出的病原菌及其耐药性进行回顾性分析.结果 222例患儿共分离出348株病原菌,标本来源为痰、血液、尿液等,其中革兰阴性菌188株、革兰阳性菌121株、真菌37株,主要病原菌为肺炎克雷伯菌、大肠埃希菌、凝固酶阴性葡萄球菌、铜绿假单胞菌及鲍曼不动杆菌.主要革兰阴性菌对美洛西林及头孢曲松的耐药率均达40%以上,而对头孢哌酮/舒巴坦耐药率较低,大肠埃希菌及鲍曼不动杆菌未发现耐药菌株.葡萄球菌对青霉素及红霉素的耐药率达80%以上,未发现对万古霉素及替考拉宁耐药菌株.真菌未发现耐药菌株.结论 我院儿童重症监护病房感染以革兰阴性菌为主,真菌感染有增高趋势,病原菌耐药情况较严重.对儿童重症监护病房感染患儿的病原菌进行监测,并对其耐药情况进行分析,对临床合理选用抗菌药物具有重要的指导意义.

Objective The aim of the study was to analyze the distribution and antibiotics resistance of pathogens in Pediatric Intensive Care Unit (PICU), and to instruct clinical reasonable application of antibiotics. Methods A retrospective analysis of infected children treated at PICU of Dalian Children's Hospitall between Jan. 2015 and Dec. 2016 was carried out to analyze the bacterial distribution and antibiotics resistance. Results A total of 348 pathogenic strains were isolated from 222 cases, including 188 strains of Gram-negative bacilli, 121 strains of Gram-positive cocci and 37 strains of fungus. The strains were isolated from sputum, blood and urine. The most common strains were Klebsiella pneumoniae, Escherichia coli, coagulase negative Staphylococcus, Pseudomonas aeruginosa and Acinetobacter baumannii. The mezlocillin and ceftriaxone resistant rates in maingram-negative bacteria were more than 40%, cefoperazone/sulbactam resistant rates were lower. There were no drug resistant strains founded in Escherichia coli and Acinetobacter baumannii. The penicillin and erythromycin resistant rates of staphylococcus were more than 80%, but no bacterial strain was founded to be resistance to vancomycin and teicoplanin. No drug resistant strains were founded in Fungus. Conclusion Gram-negative bacilli is the major pathogens in PICU in our hospital. There is an increasing tendency of fungal infection. At present, the drug resistance of pathogens is serious. Therefore, the monitoring of pathogenic bacteria in PICU and the analysis of its drug resistance have great guiding significance for antibiotics rational use in clinical practice.