单中心PICU细菌分布特点分析

Bacteria Distribution Characteristics of a Single Pediatric Intensive Care Unit

目的分析儿童重症监护室(PICU)常见细菌分布特点,为临床早期合理使用抗生素提供依据。方法回顾性研究2013年1月1日~2017年12月31日华中科技大学同济医学院附属同济医院儿童重症监护室微生物培养病原菌检测结果,统计分析该PICU常见病原菌的分布特点。结果①PICU常见细菌:14101份送检标本培养出779株非重复细菌,包括革兰阴性菌529株(67.9%),革兰阳性菌250株(32.1%)。常见病原菌依次为肺炎克雷伯菌129株(16.6%)、不动杆菌属110株(14.1%)、金黄色葡萄球菌93株(11.9%)、大肠埃希菌66株(8.5%)、肺炎链球菌57株(7.3%)等。②影响细菌分布的因素:痰培养、导管尖端培养及皮肤分泌物培养以检出革兰阴性菌为主,而血培养、尿培养及脑脊液培养以检出革兰阳性菌为主。肺炎克雷伯菌及大肠埃希菌感染好发于婴幼儿,金黄色葡萄球菌及肺炎链球菌感染好发于年长儿。随着住院时间的延长,革兰阴性菌检出率上升,而革兰阳性菌检出率下降。结论该院PICU微生物培养总阳性率不高,常见病原菌仍以革兰阴性菌为主。不同标本、不同年龄、不同住院日及不同年份病原菌分布有差异,临床经验性用药应有针对性。

Objective To analyze the characteristics of the pathogenic bacteria distribution and drug resistance in Pediatric Intensive Care Unit(PICU),then provide evidence for clinical application of antibiotics reasonably.Methods All the microbial culture of pathogenic bacteria in PICU,Tongji Hospital from Jan.2013 to Dec.2017 were analyzed retrospectively.And through the statistical analysis,the distribution characteristics of common pathogenic bacteria in the PICU were obtained.Results ① The bacteria distribution:A total of 779 non-pathogenic bacterial specimen strains were isolated from 14101 samples,G-bacteria and G+ bacteria accounted for 67.9% and 32.1%,respectively.The main pathogens were 129 strains of Klebsiella pneumoniae(16.6%),110 strains of Acinetobacter spp(14.1%),93 strains of Staphylococcus aureus(11.9%),66 strains of Escherichia coli(8.5%),57 strains of Streptococcus pneumoniae(7.3%),etc.② The factors affecting the distribution of bacteria:sputum culture,catheter tip culture and skin secretion culture were dominated by G-bacteria,while blood culture,urine culture and cerebrospinal fluid culture were dominated by G+ bacteria.Klebsiella pneumoniae and Escherichia coli infection mainly occurred in infants,while Staphylococcus aureus and Streptococcus pneumoniae infection showed high detection rate in older children.As the duration of hospitalization increased,the detection rate of G^- bacteria increased,while G^+ bacteria decreased.Conclusion In our hospital,the common bacteria of PICU were mainly G^- bacteria.The distribution of pathogenic bacteria is different among different specimens,ages,hospitalization days and years,so we should be targeted at the clinical empirical drug use.