儿童医院多药耐药菌分布及耐药性变迁

Distribution of multidrug-resistant bacteria and changes of drug resistance in the children′s hospital

目的监测多药耐药菌(MDRs)在儿童医院的分布及其耐药性变化,为临床合理使用抗菌药物及采取有效的预防控制措施提供依据。方法收集2010年1月-2012年12月7个临床重点科室住院患者的各类阳性标本5 904份,分离到MDRs776株,采用美国BD公司生产的phoenix 100全自动分析仪进行微生物菌株鉴定及药敏分析。结果 MDRs在临床科室分布广泛,MDRPA主要分布在急救内科,占33.9%,MDRAB主要分布在新生儿科,占45.1%,MRSA主要分布在普外科,占46.2%;MDRs在不同的标本中所占比例不同,其中MDRPA、MDRAB在痰液中分布最高,分别占77.4%、91.8%,MRSA在脓液分布最高,占46.2%;MDRPA对磺胺甲噁唑/甲氧苄啶、氯霉素、头孢曲松的耐药率>80.0%,MDRAB对大多数抗菌药物耐药率均>50.0%,其中对头孢类抗菌药物的耐药率>70.0%,MRSA对万古霉素、磺胺甲噁唑/甲氧苄啶、庆大霉素等耐药率<40.0%,但由于有些药物的不良反应不能用于儿童,应慎用或禁用。结论在不同科室多药耐药菌分布存在差异性,因此要根据科室特点有针对性加强多药耐药菌的管理,促进抗菌药物临床合理应用能力和管理水平持续提高。

OBJECTIVE To monitor distribution of multidrug-resistant bacteria（MDRs）and their changes of drug resistance in the children′s hospital and provide the basis for effective prevention and control measures and clinical rational use of antimicrobial drugs.METHODS Totally 5 904 positive specimens of each kind of MDRs were collected from seven key clinical departments during Jan.2010 to Dec.2012,and 776 strains of MDRs were separated.The phoenix 100 full-automatic analyzer（BD Co.,Ltd., US） was used for microbial strain identification and drug susceptibility test.RESULTS MDRs were widely distributed in clinical departments,including MDRPA which were mainly distributed in the emergency department of internal medicine（33.9%）,MDRAB mainly in the neonatology department（45.1%）,MRSA mainly in the department of general surgery（46.2%）.The proportions of MDRs in different specimens were different.MDRPA,and MDRAB had the highest detection rate in sputum,the proportions were 77.4% and 91.8%;MRSA had the highest detection rate in pus,the proportion was 46.2%.Drug resistance rate of MDRPA was greater than 80% to sulfamethoxazole/trimethoprim,chloramphenicol,and ceftriaxone.MDRAB were resistant to most antibiotics,with the drug resistance rate more than 50%,especially over 70% to cephalosporins.MRSA had the drug resistance rate less than40% to vancomycin,sulfamethoxazole/trimethoprim,and gentamicin.Because of the adverse reactions,some drugs should be carefully administrated or forbidden for children.CONCLUSION Distribution of multi-resistant bacteria exhibits difference in different departments,therefore the management of multi-resistant bacteria should be strengthened according to the characteristics of the targeted department,so as to promote the ability of clinical reasonable application of antimicrobials and continuously improve the management level.