2017-2020年成都某基层医院儿科病区病原菌分布及耐药性变迁

Pathogen distribution and drug resistance changes in pediatric wards of a primary hospital in Chengdu from 2017 to 2020

目的了解本院近4年儿科病区病原菌的分布及耐药性变迁,为指导临床合理用药,延缓多重耐药菌产生提供理论依据。方法收集2017年1月至2020年3月本院儿科病区分离的菌株资料,菌株鉴定及药敏试验采用VITEK 2自动化仪器法联合KB法,结果判断采用美国临床实验室标准化委员会(CLSI)2017年标准。结果本研究共分离到845株细菌,其中革兰阳性菌486株(55.8%),革兰阴性菌359株(42.2%),前5位分离株依次为:金黄色葡萄球菌394株(46.6%),大肠埃希菌160株(18.9%),肺炎克雷伯菌42株(5.0%),阴沟肠杆菌30株(3.6%),流感嗜血杆菌25株(3.0%)。在病区分布上,新生儿病区542株(64.1%),普儿病区248株(35.9%)。耐甲氧西林金黄色葡萄球菌(MRSA)在新生儿组和非新生儿组的检出率分别为32.8%和20.6%,产超广谱β-内酰胺酶(ESBLs)肠杆菌在两组的检出率分别为22.6%和24.2%,未分离出耐碳青霉烯类菌株。MRSA分离率从2017年的16.4%上升至2020年的30.2%,产ESBLs大肠埃希菌检出率从2017年22.7%上升至2020年33.3%。结论本院儿科患者感染细菌以金黄色葡萄球菌和大肠埃希菌居多,且多重耐药菌检出率逐年增高,应引起临床重视并加强抗生素的合理应用,减少或延缓耐药株的出现。

Objective To understand the distribution of pathogenic bacteria in the pediatric wards and the change of drug resistance in our hospital in the past four years,and to provide a theoretical basis for guiding clinical rational drug use and delaying the emergence of multi-drug resistant bacteria.Methods The data of the strains isolated from the pediatric ward of our hospital from January 2017 to March 2020 were collected.The strain identification and drug sensitivity test adopts the VITEK 2 auto-mated instrument method combined with the KB method.The results were evaluated according to the 2017 Standards of the American Clinical Laboratory Standardization Committee(CLSI).Results A total of 845 bacteria were isolated in this study,including 486 Gram-positive bacteria(55.8%)and 359 Gram-negative bacteria(42.2%).The top five isolates were 394 strains of Staphylococcus aureus(46.6%),160 strains of Escherichia coli(18.9%),42 strains of Klebsiella pneumoniae(5.0%),and 30 strains of Enterobacter cloacae(3.6%),and 25 strains of Haemophilus influenzae(3.0%).In terms of the distribution of wards,there were 542(64.1%)neonatal wards and 248(35.9%)puerperal wards.The detection rates of methicillin-resistant Staphylococcus aureus(MRSA)in neonatal and non-neonatal groups were 32.8%and 20.6%,respectively.The detection rates of Enterobacteriaceae producing extended-spectrumβ-lactamase(ESBLs)in the two groups were 22.6%and 24.2%,respectively,and no carbapenem-resistant strains were isolated.The MRSA separation rate increased from 7.3%in 2017 to 18.8%in 2020,and the detection rate of ESBLs-producing Escherichia coli increased from 22.7%in 2017 to 33.3%in 2020.Conclusion The majority of pediatric patients in our hospital were infected with Staphylococcus aureus and Escherichia coli,and the detection rates of multi-drug resistant bacteria were increasing year by year.It should attract clinical attention and strengthen the rational application of antibiotics to reduce or delay the emergence of drug-resistant strains.