宁波地区儿科重症监护病房感染病原菌分布

Distribution of pathogens in pediatric intensive care unit in Ningbo

目的探讨本地区儿童重症监护病房细菌病原学分布,指导临床合理用药。方法对2010年1月至2014年12月宁波市妇女儿童医院住院患儿各类感染标本行细菌培养并分析。结果送检标本6 601份,共分离出病原菌1 505株,标本来源为经气道吸取的深部痰66.8%,血液培养21.9%,中段尿培养3.1%,脑脊液2.5%,胸腹水1.9%,粪便1.6%。1 505份菌株中,革兰氏阳性菌(G+)425株(28.2%),革兰氏阴性菌(G-)1 006株(66.8%),真菌74株(4.9%)。鲍曼不动杆菌和嗜麦芽窄食单胞菌5年检出率呈下降趋势(x^2值分别为93.2280和14.0520,均P<0.05),大肠埃希菌5年检出率逐年上升(x^2=14.6808,P<0.05)。呼吸机相关性肺炎主要病原菌为肺炎克雷伯菌(25.1%)、鲍曼不动杆菌(20.7%)、大肠埃希菌(13.7%)、嗜麦芽窄食单胞菌(11.0%)、金黄色葡萄球菌(8.4%)和铜绿假单胞菌(7.0%)。医院内获得性感染病原菌以肺炎克雷伯菌(42例)、大肠埃希菌(29例)、鲍曼不动杆菌(126例)、表皮葡萄球菌(14例)为主。混合感染占检出菌4.3%。结论肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌、大肠埃希菌、表皮葡萄球菌、阴沟肠杆菌为本地区儿科重症监护病房常见病原菌,仍以革兰氏阴性菌为主,应加强动态监测病区菌群分布。

Objective To investigate the distribution of pathogens in intensive care unit （ICU） so as to guide clinical drug administration. Methods The strains isolated from clinical samples in the ICU of Ningbo Women and Children＇ s Hospital from January 2010 to December 2014 were retrospectively analyzed. Results In 6 601 samples, 1 505 pathogen strains were isolated. Pathogens came from sputum （66.8%）, blood （21.9%）, urine （3.1%）, cerebrospinal fluid （2.5%）, pleural effusion （ 1.9% ） and stools （ 1.6% ）. There were 425 stains of Gram-positive bacteria （28.2%）, 1 006 stains of Gram-negative bacteria （66.8%） and 74 stains of fungi （4.9%）. During the past five years, the overall detection rate of Acinetobacter baumannii and Stenotrophomonas maltophilia were in download trend （χ^2 value was 93. 2280 and 14.0520, respectively, both P 〈 0. 05）, while the prevalence rate of Escherichia coli increased year by year （χ^2= 14.6808, P 〈 0.05 ）. The most common pathogens of ventilator-associated pneumonia （VAP） were Klebsiella pneumoniae （ 25.1% ）, Acinetobacter baumannii （ 20. 7% ）, Escherichia coli （ 13. 7% ）, Stenotrophomonas mahophilia （ 11. 0% ）, Staphylococcus anreus （8.4%） and Pseudomona aeruginosa （7.0%）. The dominant pathogens of hospital acquired infection were klebsiella pneumoniae （42 cases）, Escherichia coli （29 cases）, Acinetobacter baumannii （126 cases）, and Staphylococcus epidermidis （14 cases）. The combined infection accounted for 4.3%. Conclusion The most common pathogens of local pediatric ICU are Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus anreus, Escherichia coli, Staphylococcus epidermidis and Enterobacter cloacae. Gram-negative bacteria predominate, and it is important to carry out dynamic surveillance of bacterial distribution for appropriate using of antibiotics.