儿科临床分离细菌耐药性分析

Analysis of bacterial resistance in clinical isolates of pediatric department

目的了解北京大学第一医院2007年至2016年儿科住院患者临床分离细菌的分布及抗菌药物耐药情况。方法收集2007年1月至2016年12月儿科病房临床分离的非重复细菌,用纸片扩散法或自动化仪器法进行抗菌药物敏感性试验,按照美国临床和实验室标准协会(CLSI) 2015标准判定药物敏感结果,用WHONET 5. 6软件进行统计分析。结果 10年期间共分离2593株非重复细菌,其中革兰阳性菌占54. 5%,革兰阴性菌占45. 5%。分离最多的细菌前五位分别为:大肠埃希菌(16. 0%)、表皮葡萄球菌(14. 1%)、屎肠球菌(10. 8%)、肺炎克雷伯菌(10. 6%)、金黄色葡萄球菌(8. 4%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为24. 1%和72. 3%,葡萄球菌中未发现对万古霉素和利奈唑胺耐药的菌株。屎肠球菌对万古霉素总耐药率为1. 1%,对利奈唑胺总耐药率为0. 4%,粪肠球菌未检出对万古霉素和利奈唑胺耐药菌株。大肠埃希菌对亚胺培南总耐药率为1. 5%,对美罗培南总耐药率为1. 9%。肺炎克雷伯菌对亚胺培南总耐药率为8. 9%,对美罗培南总耐药率为9. 2%。非发酵糖革兰阴性杆菌中,鲍曼不动杆菌对亚胺培南和美罗培南的总耐药率分别为39. 5%和40. 3%,铜绿假单胞菌对亚胺培南和美罗培南的总耐药率分别为11. 1%和7. 2%。结论儿科病房临床标本中分离的MRSA、耐碳青霉烯类肠杆菌科细菌(CRE)和耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率不断增加,应采取行之有效的感染控制措施。

Objective To investigate the distribution and antibiotic resistance of clinical isolates from inpatients in pediatric department of Peking University First Hospital during the period from 2007 to 2016.Methods All isolates were collected from pediatric inpatients from 2007 to 2016.Antimicrobial susceptibility testing(AST)was performed with Kirby-Bauer or automated instrument method.The results were analyzed by WHONET 5.6 software according to CLSI 2015 breakpoints.Results A total of 2593 strains were include,most(54.5%)of which were gram-positive isolates and the rest of which(45.5%)were gram-negative isolates.The 5 most common bacteria were Escherichia coli(16.0%),Staphylococcus epidermidis(14.4%),Enterococcus faecium(10.8%),Klebsiella pneumonia(10.6%)and Staphylococcus aureus(8.4%).Methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant coagulase-negative Staphylococcus(MRCNS)accounted for 24.1%and 72.3%.No Staphylococcal strains resistant tovancomycin or linezolid was detected.1.1%of the Enterococcus faecium isolates were resistant to vancomycin.0.4%of the Enterococcus faecium isolates were resistant to linezolid.No Enterococcus faecalis strains resistant to vancomycin or linezolid were found.The resistance rate to imipenem and meropenem of E.coli were 1.5%and 1.9%,8.9%and9.2%of K.Pneumoniae strains were resistant to imipenem and meropenem,respectively.In non-fermentation bacteria,up to 39.5%and 10.3%of A.Baumannii were resistant to imipenem and meropenem,respectively,11.1%and 7.2%of P.Aeruginosa were resistant to imipenem and meropenem.Conclusion MRSA and the carbapenem-resistant strains of Enterobacteriaceae(CRE)and A.Baumannii(CRAB)are still on the rise in pediatric inpatients,which implies the importance of strengthening infection control.