住院危重儿童的细菌感染分布和药物敏感性变化研究

Changes of Bacterial Distribution and Drug Susceptibility in Hospitalized Critically Ill Children

目的:分析本院住院危重儿童的细菌感染分布和药物敏感性变化情况。方法:分析2017年1月~2021年12月本院儿童重症监护病房(PICU)所有临床分离细菌的特征、主要病原菌5年内的耐药性总体变化趋势。结果:PICU共送检样本7301例次,共检出非重复菌株2577株,主要来自呼吸道(63.17%)、血液与骨髓(13.89%)。2577株菌株中,72.56%为革兰阴性菌,以鲍曼不动杆菌(30.50%)、肺炎克雷伯菌(10.28%)为主;27.44%为革兰阳性菌,以金黄色葡萄球菌(7.68%)为主。2577株菌株中,碳青霉烯类耐药鲍曼不动杆菌(CR-AB)、产超广谱β内酰胺酶-肺炎克雷伯菌(ESBLKPN)、产超广谱β内酰胺酶-大肠埃希菌(ESBL-ELO)的检出率较高,且多重耐药菌出现率均较高。鲍曼不动杆菌对氯苄西林、哌拉西林、复方磺胺甲唑片的耐药率较高;肺炎克雷伯菌对氯苄西林、哌拉西林、氯苄西林/舒巴坦等的耐药率较高;金黄色葡萄球菌对青霉素、红霉素的耐药率较高。结论:住院危重儿童的细菌多发呼吸道感染中,病原菌以革兰阴性菌为主,且多重耐药菌检出率较高,主要病原菌5年内的耐药性总体无明显变化,但耐药情况严重,临床中应加强细菌检测及合理用药。

Objective:To analyze the changes of bacterial distribution and drug sensitivity in hospitalized critically ill children.Methods:The characteristics of all clinically isolated bacteria in the pediatric intensive care unit(PICU)of our hospital and the overall trend of drug resistance of major pathogens within 5 years were analyzed.Results:From January 2017 to December 2021,a total of 7301 samples were sent from children in PICU,and a total of 2577 non-repeated strains were detected,mainly from the respiratory tract(63.17%),blood and bone marrow fluid(13.89%).Among the 2577 strains,72.56%were Gram-negative bacteria,mainly Acinetobacter baumannii(30.50%)and Klebsiella pneumoniae(10.28%),and the remaining 27.44%were Gram-positive bacteria,with Staphylococcus aureus(7.68%)mainly.The detection rates of carbapenem-resistant Acinetobacter baumannii(CR-AB),Staphylococcus aureus Klebsiella pneumoniae(ESBL-KPN)and Staphylococcus aureus EScherichia coli(ESBL-ECO)were higher among 2577 strains,and the occurrence rates of multiple drug-resistant bacteria were higher.The resistance rate of Acinetobacter baumannii to chlorbenicillin,piperacillin and compound sulfamethoxazole was high.The drug resistance rates of Klebsiella pneumoniae to chlorpicillin,piperacillin,chlorpicillin/sulbactam were higher,and the drug resistance rates of Staphylococcus aureus to penicillin and erythromycin were higher.Conclusion:In critically ill hospitalized children,there were many respiratory tract infections caused by bacteria,mainly gram-negative bacteria,and the detection rate of multiple drug resistant bacteria was high.The drug resistance of the main pathogens has no significant change in 5 years,but the drug resistance is serious.Therefore,bacterial detection and rational drug use should be strengthened in clinical practice.