我院儿童患者临床分离病原菌的分布及耐药性分析

Analysis of distribution and drug resistance of bacterial strains isolated from children patients in our hospital

目的:分析本院就诊儿童患者感染的病原菌分布和耐药情况,为儿科感染性疾病的防治及合理用药提供参考。方法:通过回顾性分析方法对2017—2019年本院就诊患儿临床分离的病原菌株进行统计,从病原菌标本分布、病原菌种类及耐药等方面进行分析。结果:2017—2019年就诊患儿临床分离的病原菌共计2445株,标本类型以痰液1500株(61.35%)为主,其次是脓液471株(19.26%),尿液267株(10.92%)等;2017—2019年菌群分布相似,其中革兰阴性菌1625株,占66.46%,主要为大肠埃希菌、肺炎克雷伯菌和流感嗜血杆菌;革兰阳性菌773株,占31.62%,主要为金黄色葡萄球菌;共检出耐甲氧西林金黄色葡萄球菌(MRSA)117株,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)69株,产ESBLs大肠埃希菌277株,产超广谱β内酰胺酶(ESBLs)肺炎克雷伯菌56株。与2017年比较,2018年和2019年产ESBLs的大肠埃希菌和MRSA的检出率有所增加。结论:革兰阴性菌为儿童患者细菌感染的最主要的病原菌,以大肠埃希菌、肺炎克雷伯菌居多,部分产酶菌株检出率较高,分离出的部分病原菌对临床常用的抗菌药物耐药趋势也值得关注,建议临床应关注病原菌的耐药情况,合理使用抗菌药资源,延缓耐药菌的出现和传播。

Objective:To provide an update on the management and prognosis of pediatric infections,we investigated the distribution and the drug resistance pattern of pathogenic bacteria isolated from pediatric cases in The Fifth Central Hospital of Tianjin.Methods:Specimens were collected from pediatric population in Tianjin Fifth Central Hospital from 2017-2019,and the results of pathogen species,pathogen distribution,and antimicrobial resistance were retrospectively reviewed.Results:A total of 2445 strains of pathogens were identified,including 1500 strains isolated from sputum(61.35%),471 strains from pus(19.26%),and 267 strains from urine(10.92%).There was no significant difference in bacterial distribution from 2017-2019;1625 were Gram-negative(66.46%)and 773 were Gram-positive(31.62%).Escherichia coli,Klebsiella pneumoniae,and Haemophilus influenzae were the primary Gram-negative bacteria identified,and Gram-positive strains typically included Staphylococcus aureus.Among which,117 strains were methicillin-resistant staphylococcus aureus(MRSA),69 were methicillin-resistant coagulase negative staphylococcus(MRCNS),277 were extended spectrum beta lactamases-producing Escherichia coli,and 56 were extended spectrum beta lactamases-producing Klebsiella pneumoniae.Compared with 2017,the detection rates of extended spectrum beta lactamases-producing Escherichia coli and MRSA increased in 2018 and 2019.Conclusions:Gram-negative bacteria are the main pathogen of bacterial infection in children with infections,typically including Escherichia coli and Klebsiella pneumoniae.The isolation rate of some enzyme-producing strains was high.The resistance trend of some isolated pathogens to commonly used antibiotics in clinic is also worth attention.It is suggested that clinical attention should be paid to the drug resistance of pathogenic bacteria,rational use of antimicrobial resources,and delay the emergence and spread of drug-resistant bacteria.