儿外科监护室血流感染的病原菌分布及耐药性分析

The distribution and drug resistance of pathogens of blood stream infection in pediatric surgery inten-sive care unit

目的了解儿外科重症监护病房血流感染的病原菌分布及药物敏感情况，以利于临床合理选用抗生素。方法收集2011年1月至2015年12月我院儿外科重症监护病房确诊为血流感染的138例患儿的临床资料，对病原菌分布及耐药情况进行分析。结果5年中血流感染的发生率为3．88％。（138／35524），且以1岁以下婴儿发生最多，最终死亡19例（13．77％）。138例血流感染患儿共获得179株病原菌，革兰阳性菌、革兰阴性菌和真菌感染分别占60．89％（109／179）、22．91％（41／179）和16．20％（29／179）。革兰阳性菌中凝固酶阴性葡萄球菌检出率最高（84／179，46．93％）；革兰阴性菌中前3位的是鲍曼不动杆菌（15／179，8．38％）、肺炎克雷白杆菌（12／179，6．70％）和大肠埃希菌（6／179，3．35％），其中耐碳青霉烯类鲍曼不动杆菌的检出呈逐年上升趋势；真菌中以非白色念珠菌为主（14／179，7．82％）。检出的多重耐药菌株对碳青霉烯类的耐药率明显上升。结论儿外科重症监护病房患儿的血流感染率逐年增高，且低龄儿童的病死率亦高，需要临床上注重病原学检测，以指导合理使用抗菌药物，减少耐药菌株的产生。

Objective To identify the pathogen distribution and antibiotics resistance of blood stream infection （BSI） in the pediatric surgery intensive care unit（PSICU）. Methods The clinical data of 138 pedi- atric patients diagnosed with BSI from January 2011 to December 2015 were collected in PSICU, and the dis- tribution of pathogens and drug resistance were retrospectively analyzed. Results The incidence of BSI was 3.88%（ 138/35 524）in the five years, the majority of the BSI cases occurred under one year old, and the mortality was 13.77% （19/138）. A total of 179 strains were isolated from blood samples of 138 patients, of which gram-positive bacteria,gram-negative bacteria and fungi accounted for 60. 89% （109/179） ,22. 91% （ 41/179 ） and 16. 20% （ 29/179 ） respectively. The most common gram-positive bacteria was coagulase-nega- tive staphylococcus （84/179,46. 93% ）. The predominant gram-negative bacteria were Acinetobacter bau- mannii（ 15/179,8.38% ）, Klebsiella pneumonia （ 12/179,6. 70% ） and Escherichia coli （ 6/179,3.35% ）. The rate of carbapenems-resistant Acinetobacter baumannii increased continuously in the study period. Non- albicans Candida was the most common fungi （ 14/179,7. 82% ）. The resistance rate of multi- drug resistant strains to carbapenems significantly increased. Conclusion The incidence of BSI in PSICU increases, and the mortality in children younger than one year is high. Better understanding of distribution of BSI pathogen could provide more effective antibiotic prescription.