闽南地区2017-2019年儿童患者血培养常见病原菌菌群分布及耐药性分析

Analysis of Bacterial Community Distribution and Drug Resistance of Common Pathogens in Blood Culture of Children in Southern Fujian from 2017 to 2019 years

目的:了解闽南地区2017—2019年儿童血培养阳性标本病原菌分布与耐药性,以指导临床合理用药。方法:回顾性选取2017年1月—2019年12月厦门大学附属妇女儿童医院儿科和新生儿科11 396例儿童血培养标本。所有儿童进行标本采集,病原菌鉴定及药敏试验。分析儿童血培养标本阳性率及病原菌分布情况。分析主要革兰阴性菌(大肠埃希菌、嗜麦芽假单胞菌)、主要葡萄球菌(凝固酶阴性葡萄球菌、金黄色葡萄球菌)、主要链球菌(肺炎链球菌、无乳链球菌)对常见抗菌药物的耐药性。结果:2017-2019年本院儿童送检血培养标本11 396份,分离出非重复血培养病原菌354株,阳性率为3.11%,其中革兰阳性菌243株(68.64%)、革兰阴性菌109株(30.79%)、真菌2株(0.56%),占比居前5位的分别为凝固酶阴性葡萄球菌(46.89%)、大肠埃希菌(11.02%)、嗜麦芽假单胞菌(7.91%)、其他革兰阴性杆菌(7.91%),肺炎链球菌(7.63%)。其中凝固酶阴性葡萄球菌以表皮葡萄球菌(25.99%)和人葡萄球菌(7.63%)为主。未发现大肠埃希菌对阿莫西林+克拉维酸、哌拉西林+他唑巴坦、美罗培南、亚胺培南、阿米卡星耐药,其对头孢类抗生素有较高的敏感性,而对氨苄西林、哌拉西林、四环素耐药性强。嗜麦芽假单胞菌对复方磺胺甲恶唑、氯霉素、左氧氟沙星敏感性较高。凝固酶阴性葡萄球菌和金黄色葡萄球菌对红霉素耐药性强,未检出对万古霉素、利奈唑烷、替考拉宁耐药的葡萄球菌,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐甲氧西林金黄色葡萄球菌(MRSA)的检出率分别为72.9%和45.5%。未发现肺炎链球菌对利奈唑烷、莫西沙星、替考拉宁、万古霉素、左氧氟沙星耐药,对红霉素、克林霉素耐药率高,对氯霉素、头孢菌素类药物有较高的敏感性。未发现无乳链球菌对阿莫西林、复方磺胺甲恶唑、利奈唑烷、氯霉素、美罗培南、莫西沙星、青霉素、替考拉宁、头孢吡肟、头孢噻肟、万古霉素耐药,但对红霉素、克林霉素、四环素耐药性较高。结论:闽南地区儿童血培养阳性标本的病原菌种类多,以革兰阳性球菌为主,耐药情况复杂,增加临床治疗与医院防控难度,因此及早进行病原菌耐药性检测,保证用药安全性。

Objective: To understand the pathogenic bacteria distribution and drug resistance of blood culture positive samples of children in Southern Fujian from 2017 to 2019 years, so as to guide clinical rational of drug use. Method: Blood culture specimen of 11 396 children from the Department of Pediatrics and the Department of Neonatology of Women and Children’s Hospital of Xiamen University, School of Medicine, Xiamen University from January 2017 to December 2019 were retrospectively selected. All children underwent specimen collection, pathogen identification and drug susceptibility test. The positive rate of blood culture specimens and the distribution condition of pathogenic bacteria in children were analyzed. The resistance of major Gram-negative bacteria(escherichia coli, pseudomonas maltophilus), major staphylococci(coagulase negative staphylococcus, staphylococcus aureus), and major streptococci(streptococcus pneumoniae, streptococcus agalactiae) to common antimicrobial drugs was analyzed. Result: From 2017 to 2019 years,11 396 blood culture specimen were submitted for inspection from children in our hospital, and 354 pathogens were isolated from nonduplicate blood culture, with a positive rate of 3.11%, including 243(68.64%) Gram-positive bacteria, 109(30.79%) Gram-negative bacteria and 2(0.56%) fungi. The top five of proportion were coagulase-negative staphylococcus(46.89%), escherichia coli(11.02%),pseudomonas maltophilia(7.91%), other Gram-negative bacilli(7.91%) and streptococcus pneumoniae(7.63%). The coagulase-negative staphylococci were mainly staphylococcus epidermidis(25.99%) and staphylococcus hominis(7.63%). No escherichia coli was found to be resistant to Amoxicillin + Clavulanic Acid, Piperacillin + Tazobactam, Meropenem, Imipenem and Amikacin. It was highly sensitive to cephalosporins, but strongly resistant to Ampicillin, Piperacillin and Tetracycline. Pseudomonas maltophilia was highly sensitive to Compound Sulfamethoxazole, Chloramphenicol and Levofloxacin. Coagulase-negative staphylococcus and staphylococcus aureus were strongly resistant to Erythromycin, and no staphylococcus resistant to Vancomycin, Linezolid and Teicoplanin was detected. The detection rates of methicillin-resistant coagulase-negative staphylococcus(MRCNS) and methicillin-resistant staphylococcus aureus(MRSA)were 72.9% and 45.5% respectively. Streptococcus pneumoniae was not found to be resistant to Linezolid, Moxifloxacin, Teicoplanin,Vancomycin and Levofloxacin, but was highly resistant to Erythromycin and Clindamycin, and was highly sensitive to Chloramphenicol and Cephalosporins. No streptococcus agalactiae was found to be resistant to Amoxicillin, Compound Sulfamethoxazole, Linezolid,Chloramphenicol, Meropenem, Moxifloxacin, Penicillin, Teicoplanin, Cefepime, Cefotaxime and Vancomycin, but it was highly resistant to Erythromycin, Clindamycin and Tetracycline. Conclusion: There are many kinds of pathogenic bacteria in blood culture positive samples of children in southern Fujian region, mainly Gram-positive cocci, and the drug resistance condition is complex, which increases the difficulty of clinical treatment and hospital prevention and control. Therefore, drug resistance detection of pathogenic bacteria should be carried out as early as possible to ensure the safety of use in drug.