2014-2016年某儿童医院呼吸内科病区病原菌的情况及其耐药分析

Analysis of pathogenic bacteria and antibiotic resistance in respiratory department of internal medicine of a children's hospital in 2014-2016

目的:监测呼吸内科病区病原菌的分布及耐药情况,为儿童呼吸科临床合理选用抗菌药物提供依据。方法:分析2014-2016年儿呼吸内科病区送检标本的病原菌及耐药情况。结果:病原菌检出率13.28%,其中革兰阴性菌970株(49.06%);革兰阳性菌786株(39.76%);真菌221株(11.18%)。居其前7位菌株依次为金黄色葡萄球菌625株(31.61%),大肠埃希菌73株(15.63%),肺炎克雷伯菌220株(11.13%),鲍曼复合醋酸钙不动杆菌95株(4.81%),铜绿假单胞菌78株(3.95%),阴沟肠杆菌78株(3.95%),肺炎链球菌60株(3.03%)。耐甲氧西林金黄色葡萄球菌(MRSA)检出393株,占金黄色葡萄球菌的62.88%;大肠埃希菌和肺炎克雷伯菌中产ESBLs菌株分别占39.48%和77.73%;鲍曼不动杆菌95株和铜绿假单胞菌78株,对头孢他啶、头孢哌酮舒巴坦、哌拉西林他唑巴坦、碳青霉烯类、喹诺酮类等药物较敏感;肺炎链球菌60株,其对红霉素、克林霉素耐药较高,而对青霉素、头孢呋辛、头孢曲松、万古霉素等敏感性较好。结论:儿童呼吸分离的病原菌以革兰阴性菌为主,耐甲氧西林金黄色葡萄球菌比例最高,需根据患儿病情,给予恰当的治疗,应加强抗菌药物的临床合理使用。

Objective:To monitor the distribution and drug resistance of pathogenic bacteria in respiratory ward and provide evidence for rational selection of antibiotics in children's respiratory department.Methods:We analyzed the pathogens and drug resistance of the specimens sent to the respiratory department in children from2014 to 2016.Results:The detection rate of pathogenic bacteria was13.28%,of which970 were Gram-negative bacteria(49.06%).There were 786 Gram-positive bacteria(39.76%)and 221 fungi(11.18%).The top7strains were staphylococcus aureus 625 strains(31.61%),Escherichia coli 73 strains(15.63%),Klebsiella pneumoniae 220 strains(11.13%),Acinetobacter baumannii95strains(4.81%),Pseudomonas aeruginosa 78 strains(3.95%),Enterobacter cloacae78strains(3.95%)and Streptococcus pneumoniae 60 strains(3.03%).393 strains of methicillin-resistant staphylococcus aureus(MRSA)were detected,accounting for 62.88% of Staphylococcus aureus.The ESBLs strains of Escherichia coli and Klebsiella pneumoniae accounted for 39.48% and 77.73%respectively.95 strains of Acinetobacter baumannii and78strains of Pseudomonas aeruginosa,sensitive to ceftazidime,cefoperazone sulbactam,piperacillin tazobactam,carbapenems,quinolones and other drugs.60 strains of Streptococcus pneumoniae,which are more resistant to erythromycin and clindamycin,but better to penicillin,cefuroxime,ceftriaxone and vancomycin.Conclusion:Gram-negative bacteria are the main pathogenic bacteria in children's respiratory isolation,and methicillin-resistant Staphylococcus aureus is the highest.It is necessary to give proper treatment according to the condition of the children and strengthen the rational use of antibiotics in clinic.