34例儿童败血症病原菌及耐药性分析

目的了解成都市第三人民医院收治的儿童败血症的病原菌及耐药性,为临床用药提供依据。方法 2004年1月～2010年3月收治的34例经血培养确诊的败血症患儿的病原菌分布、耐药及临床特点等进行分析。结果 34例标本中其中革兰阳性菌23株,以葡萄球菌为主,其次为肺炎链球菌、草绿色链球菌、溶血隐秘杆菌,而葡萄球菌中以表皮葡萄球菌为多,次为溶血葡萄球菌、金黄色葡萄球菌,对多种抗生素耐药,对青霉素、红霉素、四环素的耐药率高达50%～100%,对万古霉素100%敏感;革兰阴性菌11株,以猪霍乱沙门菌为主,其次为大肠埃希菌、鲁氏不动杆菌、嗜麦芽窄食单胞菌、产酸克雷伯菌、发酵菌某些种、阴性杆菌,对氨苄西林、复方新诺明、庆大霉素耐药率较高。结论儿童败血症的病原菌以G^＋菌为主,新生儿期感染均为葡萄球菌,以表皮葡萄球菌为多,肺炎链球菌是除新生儿期外的3岁以下儿童败血症的常见病原菌;青霉素、红霉素、四环素、氨苄西林、复方新诺明、庆大霉素的耐药率高,已经不适宜作基础药物;抗革兰阳性菌可选用苯唑西林、头孢噻肟、万古霉素、庆大霉素、左氧氟沙星;抗革兰阴性菌可选用阿莫西林/棒酸、头孢吡肟、头孢西丁、替卡西林/棒酸、阿米卡星、环丙沙星、左氧氟沙星、亚胺培南。

Distribution and antibiotic susceptibility of pathogens isolated in 34 cases of children septicemia

Objective To investigate pathogens in children admitted in Third People′s Hospital of Chengdu septicemia and antimicrobial resistance of these bacteria in recent years to guide the clinical treatment.MethodsThe data of 34 children septicemia confirmed by hemoculture from January 2004 to March 2010 in our hospital were analyzed pathogen distribution,resistance and clinical characteristics.ResultsSpecimens in 34 cases of Gram-positive bacteria of which 23,mainly by Staphylococcus aureus,followed by Streptococcus pneumoniae,viridans streptococci,hemolytic hidden bacteria,Staphylococcus epidermidis and Staphylococcus as many times as Staphylococcus haemolyticus,Staphylococcus aureus,resistant to many antibiotics,penicillin,erythromycin and tetracycline resistance rates as high as 50%～100%,100% sensitive to vancomycin;11 strains of Gram-negative bacteria to choleraesuis Salmonella-based,followed by Escherichia coli,Lu baumannii,Stenotrophomonas maltophilia,Klebsiella acid production,fermentation of certain kinds of bacteria,negative bacilli to ampicillin,a new compound Connaught Ming,high resistance to gentamicin.ConclusionChildren with G^＋ sepsis bacterial pathogens mainly neonatal infections are Staphylococcus aureus, Staphylococcus epidermidis is more, Streptococcus pneumoniae is in addition to the neonatal period for children under 3 years of age outside the common pathogens of sepsis ; penicillin, erythromycin, tetracycline, ampicillin, cotrimoxazole, gentamicin re- sistance rates have not suitable for basic drugs; against Gram-positive bacteria can be used oxacillin, cefotaxime, vancomycin , gentamicin, levofloxacin; resistant Gram-negative bacteria can be used amoxicillin / clavtdanic acid, cefepime, cefoxitin, ticarcillin / claxadanic acid, amikacin, ciprofloxacin, levofloxacin, imipenem.