儿童重症监护病房病原菌分布及耐药性分析

目的 调查2008年武汉市儿童医院重症监护病房(PICU)病原菌的分布及耐药情况,为临床合理选用抗菌药物提供依据.方法 采用VITEK-32微生物全自动鉴定系统鉴定细菌菌种,以纸片扩散法进行药敏试验,按美国临床及实验室标准化协会(CLSI)2008年标准操作.结果 全年共分离细菌584株,其中革兰阴性杆菌68.15%,革兰阳性球菌21.58%,真菌10.27%.大肠埃希菌和肺炎克雷伯菌属超广谱β-内酰胺酶产生率分别为57.77%和58.62%.耐甲氧西林凝固酶阴性葡萄球菌检出率为75.00%.药敏结果显示,大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌对亚胺培南、美洛培南、环丙沙星、阿米卡星最敏感,其次为哌拉西林/他唑巴坦;鲍曼不动杆菌耐药性较低的抗生索依次为环丙沙星、阿米卡星、头孢哌酮/舒巴坦,对碳青霉烯类耐药率达50%以上;嗜麦芽窄食单胞菌对复方新诺明最敏感,其次为环丙沙星,对碳青霉烯类耐药率达100%;革兰阳性球菌对万古霉素、替考拉宁和利奈唑胺最敏感.结论 我院PICU优势病原菌为革兰阴性杆菌,以大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌为主.各类细菌对常用抗菌药物表现为高度多重耐药,临床应依据细菌病原学及耐药性资料合理选择抗菌药物.

Distribution and drug resistance of pathogenic bacteria in Pediatric Intensive Care Unit

Objective To study the distribution of the pathogenic bacteria and drug resistancefeatures in Pediatric Intensive Care Unit (PICU) of Wuhan Children's Hospital in 2008 in order to provide the evidences for reasonable use of antibiotics.Methods VITEK -32 automicroscan was used to identify the species and conduct drug resistance test.The results were interpreted according to the guideline of Clinical and Laboratory Standards Institute (CLSI) (2008).Results A total of 584 strains were isolated in 2008.68.15% were gram - negative bacteria (GNB).21.58% were gram - positive bacteria (GPB) and 10.27% were fungi.The prevalence of extended- spectrum beta -lactamase of Escherichia coli and KlebsieUa pneumonia was 57.77% and 58.62% respectively.75% of coagulase negative Staphylococcus was methicillin - resistant (MRCNS).The results of drug sensitivity tests indicated that Escherichia coli, Klebsilla pneumonia, Enterobacter cloacae were highly susceptible to imipenem, meropenem, amikacin, ciprofloxacin and piperacillin - tszobactam in proper order.The antibiotics remaining the most active against Acinetohacter haumannii were ciprofloxacin and amikacin,followed by cefoperazone - sulbactam.The rate of drug- resistance to carbapenems was up to 50%.For the Stenotrophomonas maltophilia, the highest sensitivity was sulfamethoxazole -trimethoprim, followed by ciprofloxacin, but it had 100% of drug - resistance to carhapenems.GPB was highly susceptible to vancomycin, teicoplanin and liuezolid.Conclusion The main distribution of the pathogens in PICU is the gram - negative bacteria: Escherichia coli, Klebsilla pneumonia and Acinetohacter baumannii are the primary pathogens.The isolated pathogens show serious multi - drug resistance.We should select the antibiotic according to the results of drug sensitivity test.