儿童重症监护病房临床分离细菌分布特征与耐药性变迁

Distribution characteristics and drug resistance changes of bacteria detected in the pediatric intensive care unit

目的了解儿童重症监护病房(PICU)临床分离细菌分布特征及其耐药性变迁,为合理选用抗生素提供依据。方法总结2010年1月至2018年12月上海交通大学附属儿童医院PICU所有临床分离菌的分布特征及耐药性总体变化趋势。结果共分离细菌2749株,革兰阴性菌1912株,占69.6%;革兰阳性菌837株,占30.4%。分离率前6位细菌依次为鲍曼不动杆菌(749株,27.2%)、肺炎克雷伯菌(289株,10.5%)、金黄色葡萄球菌(214株,7.8%)、嗜麦芽窄食单胞菌(207株,7.5%)、大肠埃希菌(204株,7.4%)和铜绿假单胞菌(189株,6.9%);其中嗜麦芽窄食单胞菌逐年增长显著,由2010年检出6株(2.8%)至2018检出39株(9.5%)。鲍曼不动杆菌和肺炎克雷伯菌对碳青霉烯类耐药率逐年上升,至2018年耐美罗培南的检出率高达96.0%和71.4%;对第三代头孢菌素、氨基糖苷类和磺胺类抗菌药物耐药检出率均>70.0%;对替加环素、多黏菌素敏感率为100.0%。耐甲氧西林金黄色葡萄球菌(MRSA)检出率逐年增长,由2010年检出率18.2%增高至2018年检出率50.0%,增长趋势有统计学意义(χ^(2)=19.38,P=0.013)。未发现万古霉素耐药的菌株。结论革兰阴性菌是PICU主要临床分离菌,鲍曼不动杆菌、肺炎克雷伯菌,尤其是嗜麦芽假单胞菌增长趋势明显。鲍曼不动杆菌与肺炎克雷伯菌对碳青霉烯类抗菌药物耐药情况严重。MRSA逐年增长,但仍保持对万古霉素的高度敏感性。

Objective To investigate the tendency of bacterial distribution and drug resistance of clinically isolated pathogens in the pediatric intensive care unit(PICU),which provided references for the reasonable application of antibiotics.Methods The distribution characteristics of all clinical isolates from PICU of Children′s Hospital of Shanghai Jiaotong University from January 2010 to December 2018 and their trend of drug resistance were retrospectively analyzed.Results A total of 2749 strains of bacteria were isolated,including 1912 strains(69.6%)Gram-negative bacteria and 837 strains(30.4%)Gram-positive bacteria.The top 6 detected bacteria were Acinetobacter baumannii(749 stains,27.2%),Klebsiella pneumoniae(289 stains,10.5%),Staphylococcus aureus(214 stains,7.8%),Stenotrophomonas maltophilia(207 stains,7.5%),Escherichia coli(204 stains,7.4%)and Pseudomonas aeruginosa(189 stains,6.9%).Among them,the detective rate of Maltophilia Stenotrophomonasannually increased from 6 strains(2.8%)in 2010 to 39 strains(9.5%)in 2018.The resistance rates of Acinetobacter baumannii and Klebsiella pneumoniae to carbapenems increased year by year,which was up to 96.0%and 71.4%to Meropenem by 2018.Their resistance rates to the third-generation cephalosporins,aminoglycosides and sulfonamides were higher than 70.0%.The sensitivity rate to Tigecycline and Polymyxin was 100.0%.The detection rate of Methicillin-resistant Staphylococcus aureus(MRSA)significantly increased from 18.2%in 2010 to 50.0%in 2018(χ^(2)=19.38,P=0.013).No Vancomycin-resistant strains were found.Conclusions Gram-negative bacteria are the main clinical isolates of PICU.Acinetobacter baumannii,Klebsiella pneumoniae,and especially Pseudomonas maltophilus,have a significant growth trend in the detection rate.Acinetobacter baumannii and Klebsiella pneumoniae are highly resistant to carbapenems.MRSA annually grows,but it still maintains a high degree of sensitivity to Vancomycin.