2013-2018年儿童血流感染病原菌分布及耐药性分析

Analysis of pathogen distribution and drug resistance in children with bloodstream infection from 2013 to 2018

目的了解天津市儿童2013-2018年血流感染(BSI)病原菌分布及抗生素耐药情况,指导临床合理使用抗生素。方法回顾性分析天津市儿童医院2013-2018年患儿血培养分离病原菌的分布及耐药性。结果分离出1385株病原菌,其中革兰阳性菌78.27%,年份间差异有统计学意义(P<0.05),以凝固酶阴性葡萄球菌(CNS)为主,未发现万古霉素、利奈唑胺的耐药株、对红霉素、青霉素耐药率较高。革兰阴性菌占20.94%,年份间差异有统计学意义(P<0.05),以大肠埃希菌为主,对美罗培南、亚胺培南耐药率较低,对氨苄西林、复方新诺明、哌拉西林耐药率较高。结论革兰阳性菌在BSI中占主要比例,万古霉素、利奈唑胺可以作为革兰阳性菌所致BSI的经验用药,美罗培南、亚胺培南可以作为革兰阴性菌所致BSI的经验用药。

Objective To investigate the pathogen distribution and antibiotic resistance of bloodstream infection(BSI) in children in Tianjin from 2013 to 2018,so as to guide the rational use of antibiotics in clinic. Methods The distribution and drug resistance of pathogens isolated from blood culture of children in Tianjin Children’s Hospital from 2013 to 2018 were retrospectively analyzed. Results A total of 1 385 strains of pathogenic bacteria were isolated,in which gram-positive bacteria accounted for78.27%,and the differences between years were statistically significant(P<0.05). Coagulase-negative staphylococcus(CNS) was the main pathogen,the resistance strains of vancomycin and linezolid were not found,but relatively high to erythromycin and penicillin. Gram-negative bacteria accounted for20.94%,and the differences between years were statistically significant(P<0.05). Escherichia coli was the main pathogen,the resistance rates of meropenem and imipenem were low,and the resistance rates of ampicillin,cotrimoxazole and piperacillin were high. Conclusion Gram-positive bacteria were the major pathogens of BSI,vancomycin and linezolid could be used as empirical drugs for BSI caused by gram-positive bacteria,meropenem and imipenem could be used as empirical drugs for BSI caused by gram-negative bacteria.