儿童重症监护室细菌感染病原学及耐药性分析

Analysis of Pathogenicity and Drug Resistance of Bacterial Infection in Children in Intensive Care Unit

目的观察儿童重症监护病房(ICU)细菌感染情况及耐药性。方法回顾性总结我院儿童重症监护病房2015年1月—2017年12月收治的1 406例患儿,使用方法为微生物分析仪鉴定,药物敏感性试验选择K-B纸片扩散法测定。结果 (1)1 406例患儿,共分离出661株病原菌,其中338株(51.13%)革兰阴性杆菌,323株(48.87%)革兰阳性球菌;(2)革兰阴性杆菌最多见依次为克雷伯菌属(84例,12.7%),鲍曼不动杆菌(50例,7.6%)、大肠埃希菌(49例,7.4%)、阴沟肠杆菌(32例,4.8%)以及铜绿假单胞菌(26例,3.9%)等;革兰阳性杆菌最多见依次为金黄色葡萄球菌(62株,9.4%)、溶血葡萄球菌(39株,5.9%)、屎肠球菌(29株,4.4%)以及肺炎链球菌(31株,4.7%)等;(3)对革兰氏阳性菌耐药性较低药物:阿莫西林克拉维酸钾(0.93%;3/323)、亚胺培南(0.00%)、替考拉宁(0.00%);革兰氏阴性菌如大肠埃希菌对庆大霉素、哌拉西林和甲氧苄啶一磺胺甲恶唑的耐药率均接近或高于50%。结论革兰阴性杆菌与革兰阳性杆菌均是造成我院PICU患儿感染的重要原因。

Objective To observe bacterial infection and drug resistance in Pediatric ICU.Methods A retrospective summary was made of 1 406 cases of children admitted to the intensive care unit of our hospital from January 2015 to December 2017.The method was identified by microbiological analyzer.Results(1)A total of 661 pathogenic bacteria were isolated from 1 406 children,including 338(51.13%)gram-negative bacilli and 323(48.87%)gram-positive cocci.(2)Gram-negative bacilli were,in order,klebsiella(84 cases,12.7%),Acinetobacter baumannii(50 cases,7.6%),Escherichia coli(49 cases,7.4%),Enterobacter cloacae(32 cases,4.8%)and Pseudomonas aeruginosa(26 cases,3.9%);Gram-positive bacilli were most likely to be Staphylococcus aureus(62 strains,9.4%),Staphylococcus haemolyticus(39 strains,5.9%),Enterococcus faecium(29 strains,4.4%)and Streptococcus pneumoniae(31 strains,4.7%),etc.(3)Drugs with low resistance to Gram-positive bacteria:amoxicillin-clavulanate potassium(0.93%;3/323),imipenem(0%),teicoplanin(0%);Gram resistance rates of negative bacteria such as Escherichia coli to gentamicin,piperacillin and trimethoprim-sulfamethoxazole were all close to or higher than 50%.Conclusion Both gram-negative bacillus and gram-positive bacillus are important causes of infection in children with PICU in our hospital.