禹州市儿童和成人血培养阳性病原菌分布及耐药性分析

目的了解禹州市儿童和成人不同采血方式下血培养阳性的病原菌分布和耐药性,以指导临床对血流感染进行诊断,针对不同人群合理使用抗菌药物。方法收集禹州市人民医院2018年1月至2020年6月所有病区送检的血培养标本,儿科病区患儿作为儿科组,采用单次单瓶(单侧单瓶)采集血培养标本,其他病区≥18岁的成人患者作为成人组,采用单次多瓶(单侧双瓶和双侧双瓶)采集血培养标本,使用WHONET5.6分析血培养阳性的病原菌分布及耐药性。结果儿科组和成人组共送检6556份血培养标本,血培养的阳性率为4.8%,儿科组血培养阳性率为2.3%,成人组血培养阳性率为8.6%,差异有统计学意义(P<0.05)。儿科组血培养阳性的病原菌以革兰阳性菌为主,占85.6%,成人组血培养阳性的病原菌以革兰阴性菌为主,占51.3%,在细菌类别的构成上,两组差异有统计学意义(P<0.05)。儿科组血培养检出的表皮葡萄球菌对庆大霉素的耐药率为14.3%,明显低于成人组的耐药率(43.8%),差异有统计学意义(P<0.05)。儿科组和成人组血培养检出的大肠埃希菌对氨苄西林/舒巴坦、头孢哌酮/舒巴坦、头孢他啶、头孢吡肟、头孢西丁、美罗培南、庆大霉素、氯霉素的耐药率均≤50.00%,并且未检出耐碳青霉烯类抗菌药物的革兰阴性菌。结论对于儿童也应尽量单次采集多瓶血培养标本,为血流感染的诊断提供更有力的证据,并且针对不同人群合理使用抗菌药物。

Distribution and drug resistance of blood culture-positive pathogenic bacteria among children and adults in Yuzhou City

Objective To understand the distribution and drug resistance of blood culture-positive pathogenic bacteria among children and adults by different blood sampling methods to guide the clinical diagnosis of bloodstream infection,and to rationally use antimicrobial agents by aiming at different populations.Methods The blood culture samples submitted by all the patients wards of Yuzhou Municipal People′s Hospital from January 2018 to June 2020 were collected.The children patients in the pediatric ward served as the pediatric group and collected the blood sample by adopting once single bottle(unilateral side single bottle).The adult patients aged≥18 years old in the other wards served as the adult group and adopted the once multiple bottles(unilateral double bottles and bilateral double bottles).WHONET5.6 was used to analyze the distribution and drug resistance of pathogenic bacteria in blood culture-positive.Results A total of 6556 cases of blood culture samples in the pediatric group and adult group were submitted,the positive rate of blood culture was 4.8%,which of the pediatric group was 2.3%,which of the adult group was 8.6%,and the difference was statistically significant(P<0.05).The pathogenic bacteria in the pediatric group was mainly Gram-positive bacteria,accounting for 85.6%and which in the adult group was mainly gram-negative bacteria,accounting for 51.3%.The composition of bacteria categories had statistically significant difference between the two groups(P<0.05).The resistance rate of Staphylococcus epidermidis detected in blood culture of the pediatric group to gentamicin was 14.3%,which was obviously lower than 43.8%of the adult group,and the difference was statistically significant(P<0.05);the drug resistance rates of Escherichia coli detected in blood culture of the pediatric group and adult group to ampicillin/sulbactam,cefoperazone/sulbactam,ceftazidime,cefepime,cefoxitin,meropenem,gentamicin and chloramphenicol were≤50.00%,moreover no carbapenem-resistant Gram negative strain was detected.Conclusion For children patients,multiple bottles of blood culture samples should be collected as far as possible to provide stronger evidence for the diagnosis of bloodstream infection,moreover antimicrobial agents should be rationally used by aiming at different populations.