2009—2013年儿童医院血培养病原菌构成及耐药性变迁

Distribution and antimicrobial resistance of pathogens from blood culture in a children's hospital from 2009 to 2013

目的了解儿童医院血培养病原菌的构成及耐药性变迁,为儿科血流感染性疾病的治疗提供依据。方法将某院2009年1月—2013年12月住院患儿血培养分离病原菌按时间分成2009—2011年组和2012—2013年组,对病原菌构成及其药物敏感性进行分析。结果共采集48 455例患儿血培养标本,分离病原菌2 730株,阳性率5.63%。2009—2013年患儿血培养阳性率呈逐年下降趋势(χ2=415.30,P<0.01)。2 730株病原菌中,革兰阳性(G+)菌2 194株(80.37%),革兰阴性(G-)菌510株(18.68%),真菌26株(0.95%)。两组病原菌构成比较,差异具有统计学意义(χ2=180.334,P<0.001)。万古霉素、利奈唑胺和替考拉宁对主要G+球菌始终保持高敏感性(敏感率达100%),环丙沙星、复方磺胺甲口恶唑和四环素对凝固酶阴性葡萄球菌和金黄色葡萄球菌的耐药性均有下降。亚胺培南、美罗培南和阿米卡星对主要G-杆菌均保持较高的敏感性(敏感率≥97.50%),左氧氟沙星对于肺炎克雷伯菌保持较高敏感性(敏感率达100%);头孢菌素中,除头孢他啶对大肠埃希菌,头孢吡肟对肺炎克雷伯菌敏感外,其他均保持较高的耐药率。结论 2009—2013年儿童血培养病原菌构成发生明显变迁,病原菌对临床常用抗菌药物有较高的耐药性,临床应加强对血培养病原菌及其耐药性的监测。

Objective To investigate the change in distribution and antimicrobial resistance of pathogens from blood culture of children,and provide a basis for treatment of bloodstream infection.Methods Pathogens isolated from blood culture of hospitalized children between January 2009 and December 2013 were divided into group 2009-2011 and 2012-2013.Distribution and antimicrobial susceptibility of pathogens were analyzed.Results From 2009 to 2013,a total of 48 455 blood specimens were taken for culture,2 730 pathogenic bacteria were isolated,positive rate was 5.63%.The positive rate of blood culture decreased year-by-year （χ2 =415.30,P 〈0.01 ）.Of 2 730 iso-lates of pathogenic bacteria,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 80.37% （n =2 194）,18.68%（n=510）,and 0.95%（n=26）respectively.The difference between two groups of pathogenic bacte-ria was significant（χ2 =180.334,P 〈0.001）.Susceptibility rates of gram-positive cocci to vancomycin,linezolid and teicoplanin were all 100%,resistance rates of coagulase-negative Staphylococcus and Staphylococcus aureus to cip-rofloxacin,compound sulfamethoxazole and tetracycline all decreased.Susceptibility rates of gram-negative bacilli to imipenem,meropenem and amikacin were all≥97.50%,susceptibility rate of Klebsiella pneumoniae to levofloxacin was 100%;Of cephalosporins,Escherichia coli and Klebsiella pneumoniae had high resistance except ceftazidime and cefepime.Conclusion Distribution of pathogens from blood culture of children in 2009-2013 changed signifi-cantly,pathogens have high resistance to commonly used antimicrobial agents,more attention should be paid to the monitor of pathogens from blood culture and pathogenic antimicrobial resistance.