虎门地区儿童血培养病原菌的分布及耐药性

Distribution and antibiotic resistance profile of the bacterial strains isolated from blood of children in Humen region from 2016 to 2018

目的了解广东省东莞市虎门地区儿童血流感染病原菌的临床分布和耐药状况,为改进医师经验用药提供依据。方法收集本院2016年度至2018年度门诊及住院儿童患者血培养分离的病原菌及药敏数据进行回顾性分析。结果本次一共从儿童患者血培养中分离出184株病原菌。在这184个分离株中,以凝固酶阴性葡萄球菌为主(占44.0%),其次是链球菌(占13.0%),沙雷菌属(占8.7%),大肠埃希菌(占8.2%),金黄色葡萄球菌(占6.0%)等。金黄色葡萄球菌和凝固酶阴性葡萄球菌对青霉素、苯唑西林、红霉素、克林霉素耐药率相对较高,对利福平、庆大霉素的耐药率相对较低;链球菌属对四环素、复方新诺明,红霉素和克林霉素耐药率较高,对青霉素和氨苄西林耐药率较低,其中8例无乳链球菌的感染者均小于1个月的。尚未发现耐万古霉素、呋喃妥因或利奈唑胺的革兰阳性球菌,MRSA的检出率为27.3%。沙雷菌属对大部分抗菌药敏感,对复方新诺明耐药率6.2%。大肠埃希菌对氨苄西林、哌啦西林耐药率较高,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦敏感率高,超广谱β-内酰胺酶(extended spectrum beta-lactamases,ESBLs)阳性的大肠埃希菌为40.0%。结论凝固酶阴性葡萄球菌是引起本地区儿童血流感染的主要病原菌。无乳链球菌是引起新生儿血流感染、脑膜炎和肺炎等的一个重要病原菌。因此对中晚期孕妇进行筛查并治疗,是预防新生儿感染的关键。定期监测病原菌的分布和耐药性变化,对诊断儿童血流感染和医师经验用药有重要意义。

Objective To identify the bacterial pathogens causing paediatric septicaemia in a traditional Chinese Medicine Hospital and to determine their antibiogram to improve empirical antibiotic therapy.Methods The data of blood culture and antimicrobial susceptibility testing from 2016 to 2018 were collected for pediatric outpatients and inpatients.A retropective analysis was conducted with the data available.ResuIts A total of 184 strains of bacteria were isolated from children′s blood,of which coagulase negative Staphylococcus accounted for 44.0%,followed by Streptococcus(13.0%),Serratia(8.7%),Escherichia coli(8.2%),and staphylococcus aureus(6.0%).The S.aureus and coagulase negative staphylococcus isolates showed relatively higher resistance rates to penicillin,oxacillin,erythromycin and clindamycin,but lower resistance to rifampin and gentamicin.The Streptococcus were hih1y resistant to tetracycline,trimethoprim-sulfhmethoxazole,erythromycin and clindamycin,but lower resistance to penicillin and ampicillin.8 patients who were infected S.agalactiae were less than a month old.No gram-positive bacterial strains were found resistant to vancomycin,macrodantin or 1inezolid.The prevalence of MRSA was27.3%.Serratia are sensitive to most antimicrobials,with a resistance rate of 6.2%to the trimethoprim-sulfhmethoxazole.E.coil showed higher resistance rate ampicillin and piperacillin,but relatively lower resistance to cefoperazone-sulbactam and piperacillin-tazobactam.The prevalence of extended spectrum beta-lactamases positive strains was 40.0%.Conclusion Coagulase negative Staphylococcus is the principal organisms responsible for blood stream infection in a traditional Chinese Medicine Hospital.Coagulase negative Staphylococcus is the main bacterial isolates in blood culture in children.S.agalactiae mainly causes neonatal sepsis,meningitis and pneumonia.Therefore,screening and treatment of pregnant women in mid and late stage is the key to prevent neonatal infection.We should strengthen the monitoring of antimicrobial resistance of the isolates from blood samples.It is great significance to the clinical diagnosis and treatment of pediatric infection.