小儿心外科ICU病原菌分布及耐药性分析

Research on the distribution and drug resistance of pathogens in patients from pediatric cardiac surgery ICU

目的分析小儿心外科ICU患儿术后感染病原菌分布及耐药性,为临床合理选用抗菌药物提供依据。方法收集2014年1月-2015年11月小儿心外科ICU患儿送检的各类标本,分离出病原菌共221株,以美国BD公司的Phoenix100全自动细菌鉴定仪进行菌种鉴定和药敏试验,并对数据进行统计分析。结果共分离出221株病原菌,革兰阴性杆菌检出率为44.3%,以肺炎克雷伯菌和大肠埃希菌为主;革兰阳性球菌检出率为28.2%,以溶血性葡萄球菌和金黄色葡萄球菌为主;真菌检出率为26.7%,以白假丝酵母菌为主。肺炎克雷伯菌和大肠埃希菌对氨苄西林、阿莫西林/克拉维酸和氨苄西林/舒巴坦的耐药率较高。溶血性葡萄球菌对阿莫西林/克拉维酸全部耐药,金黄色葡萄球菌对青霉素和氨苄西林全部耐药。结论小儿心外科术后感染以革兰阴性杆菌为主,其次为革兰阳性菌与真菌,病原菌耐药形势严峻,应重视临床合理用药,预防控制院内感染。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in children with pediatric cardiac surgery,so as to provide evidence for clinical rational use of antibiotics. Methods Specimens were collected from children with pediatric cardiothoracic surgery from January 2014 to November 2015,and 221 strains pathogenic bacteria were isolated.The strain identifications and drug sensitivity tests were conducted with Phoenix100 from BD company of U. S. A.,with the data for statistical analysis. Results 221 strains of pathogenic bacteria were isolated,and the detection rate of gram-negative bacteria was 44. 3%,which were mainly Candida albicans and Klebsiella pneumoniae; the detection rate of gram-positive bacteria was 28. 2%,which were mainly Staphylococcus haemolyticus and Staphylococcus aureus; and the detection rate of fungi was26. 7%,with Candida albicans the dominant. Klebsiella pneumoniae and Escherichia coli to ampicillin,amoxicillin / clavulanic acid and ampicillin / sulbactam resistance rate were higher. Hemolytic Staphylococci was all resistant to amoxicillin / clavulanic acid,Staphylococcus aureus was all resistant to penicillin and ampicillin. Conclusion Most infections were caused by gram-negative bacteria after pediatric cardiothoracic surgery,followed by gram-positive bacteria and fungi. And the resistance rates of these bacteria to a variety of antimicrobial agents were very high. Therefore,rational use of antibiotics and precaution for nosocomial infection should be strengthened.