某院儿科革兰氏阳性菌感染情况及用药分析

Analysis of Gram-Positive Bacterial Infection and Drug Use In A Hospital

目的:探讨某医院儿科收治患儿革兰氏阳性菌感染及抗生素使用情况。方法:于2019年10月—2020年9月对惠州市第六人民医院儿科334例感染革兰氏病菌住院的患儿进行研究,包含174例革兰氏阳性菌感染病例。比较不同年龄、体重革兰氏阳性菌患儿病原菌构成差异,分析常见病原菌对不同药物耐药性差异及常见病原菌对不同药物耐药性不合理用药情况。结果:174例革兰氏阳性菌感染的患儿其病原菌分布为肺炎链球菌43例(占24.71%)、屎肠球菌43例(占24.71%)、粪肠球菌27例(占15.52%)、金黄色葡萄球菌18例(占10.34%)、溶血葡萄球菌16例(占9.20%)、表皮葡萄球菌14例(占8.05%)、其他13例(占7.47%)。不同年龄、体重革兰氏阳性菌患儿病原菌构成比比较,差异有统计学意义(P<0.05)。金黄色葡萄球菌耐药率超过75%的为青霉素,耐药率超过50%的为红霉素,耐药率超过30%的为克林霉素,粪肠球菌耐药率超过50%的为四环素,屎肠球菌耐药率超过75%的为红霉素,表皮葡萄球菌耐药率超过75%的为青霉素,溶血葡萄球菌耐药率超过75%的为苯唑西林。不合理用药共有21例(占12.07%),包括用法用量(10例,占5.5%)、选药不当(6例,占3.34%)、无指征用药(2例,占1.43%)、联用不当(占1.90%)。结论:医院儿科收治的革兰氏阳性菌感染患儿常见病原菌为肺炎链球菌、屎肠球菌、粪肠球菌,耐药情况和不合理用药情况也较为常见。

Objective:To investigate the gram-positive bacterial infection and antibiotic use in pediatric patients admitted to the pediatric department of a hospital.Methods:From October 2019 to September 2020,334 hospitalized children infected with gram-positive bacteria were studied in the Department of Pediatrics of the Sixth People’s Hospital of Huizhou City,including 174 cases of gram-positive bacteria infection.The differences of pathogenic bacteria composition in children with gram-positive bacteria of different age and weight were compared,and the differences of drug resistance of common pathogenic bacteria and unreasonable drug resistance of common pathogenic bacteria were analyzed.Results:The distribution of pathogens in 174 children with gram-positive bacteria infection was Streptococcus pneumoniae 43 cases(24.71%),Enterococcus faecium 43 cases(24.71%),Enterococcus faecalis 27 cases(15.52%),Staphylococcus aureus 18 cases(10.34%),Staphylococcus haemolyticus 16 cases(9.20%),Staphylococcus epidermidis 14 cases(8.05%),and other 13 cases(7.47%).There were significant differences in the constituent ratio of pathogenic bacteria among children with different age and weight(P<0.05).The resistance rates of Staphylococcus aureus were more than 75%for penicillin,more than 50%for erythromycin,more than 30%for clindamycin,more than 50%for tetracycline,more than 75%for erythromycin,more than 75%for penicillin and more than 75%for oxacillin.There were 21 cases of irrational drug use(12.07%),including usage and dosage(10 cases,5.5%),improper drug selection(6 cases,3.34%),medication without indications(2 cases,1.43%),and improper combination(1.90%).Conclusion:The common pathogens of Gram-positive bacterial infection in pediatric patients were Streptococcus pneumoniae,Enterococcus faecium and Enterococcus faecalis.Drug resistance and irrational drug use were also common.