单中心儿科多重耐药菌感染的研究

Research on multi-drug resistant bacterial infection from single center in Pediatrics

目的了解各儿科科室多重耐药菌的临床分布特点及耐药率变化趋势,为防控多重耐药菌感染提供有力依据。方法回顾性分析新乡医学院第一附属医院2014年1月1日至2016年12月31日各儿科科室分离出的573株多重耐药菌数据。结果 2014年多重耐药菌的发现率为2. 91%,2015年为1. 80%,2016年为1. 37%。573株多重耐药菌中排在前5位的是耐甲氧西林金黄色葡萄球菌(MRSA)、产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌(ECO)、多重耐药鲍曼不动杆菌(MDR-AB)、产ESBLs的肺炎克雷伯菌(KPN)、多重耐药铜绿假单胞菌(MDR-PA),分别为206株(35. 95%)、101株(17. 62%)、98株(17. 11%)、91株(15. 88%)、55株(9. 60%)。多重耐药菌株的主要科室分布:儿科重症监护病房(PICU) 201株(35. 08%)、新生儿科171株(29. 84%)、普儿科201株(35. 08%)。医院感染病例中多重耐药菌菌株共100株(8. 02%),以MDR-AB为主。MRSA对替考拉宁与万古霉素均敏感,无耐药菌株。产ESBLs ECO和产ESBLs KPN对亚胺培南、美罗培南等耐碳青霉烯类抗菌药物耐药率较低。MDR-AB对所有抗菌药物均呈现高耐药。MDR-PA对多种抗生素的敏感率均较高。结论多重耐药菌感染形势严峻,耐药率高,应积极采取相应防控措施,加强抗菌药物的合理应用。

Objective To understand the clinical distribution of multi-drug resistant bacteria in various pediatric departments and the trend of bacterial resistance rate,in order to privide the powerful evidence for the prevention and control of the multi-drug resistant bacteria infection.Methods The data of 573 strains of multi-drug resistant bacteria isolated from the inspection samples from January 1 of 2014 to December 31 of 2016 in each pediatric department of the First Affiliated Hospital of Xinxiang Medical University were retrospectively analyzed.Results The discovery rate of multi-drug resistant bacteria was 2.91%in 2014,1.80%in 2015,1.37%in 2016.Among the 573 strains of multi-drug resistant bacteria,the top five were methicillin-resistant Staphylococcus aureus(MRSA),Escherichia coli(ECO)producing extended-spectrumβ-lactamase(ESBLs),multidrug-resistant Acinetobacter baumannii(MDR-AB),Klebsiella pneumoniae(KPN)producing extended-spectrumβ-lactamase(ESBLs),multidrug-resistant Pseudomonas aeruginosa,respectively 206 strains(35.95%),101 strains(17.62%),98 strains(17.11%),91 strains(15.88%),55 strains(9.60%).The distribution of major departments of multi-drug resistant strains:201 strains(35.08%)were in Pediatric intensive care unit(PICU),171 strains(29.84%)were in Neonatology,201 strains(35.08%)were in Paediatrics.In the cases of nosocomial infections,there were 100 strains(8.02%)multi-drug resistant infection,MDR-AB was predominant.MRSA was sensitive to both koalaranin and vancomycin,there were no drug-resistant strains.The resistance rates of ECO producing ESBLs and KPN producing ESBLs to carbapenem-resistant antibiotics such as imipenem and meropenem were low.MDR-AB showed high resistance to all antibacterials.MDR-PA was more sensitive to multiple antibiotics.Conclusion The situation of multi-drug resistant infection is severe and the drug resistance rate is high.Active prevention and control measures should be taken to strengthen the rational use of antimicrobial drugs.