湖北地区1999-2004年儿童感染病原菌分布与耐药性分析

目的了解湖北地区三级甲等医院儿科临床分离菌的耐药状况,分析1999-2004年病原菌谱的变迁和2004年病原菌耐药性。方法收集6年间湖北地区15所三级医院儿科临床分离菌,用K-B方法药敏试验的抑菌圈直径输入计算机,采用WHONET5软件进行统计分析,根据美国临床实验室标准化委员会（NCCLS）2002年标准判定耐药性。结果革兰阳性菌检出构成比高于革兰阴性菌,凝固酶阴性葡萄球菌6年间逐年增加,金黄色葡萄球菌逐年下降,大肠埃希菌感染近两年位居第2位;葡萄球菌属对青霉素的耐药率〉94.0%,对红霉素、阿奇霉素的耐药率〉50.0%;耐苯唑西林凝固酶阴性葡萄球菌〉74.0%,明显高于金黄色葡萄球菌16.5%;肠球菌属对万古霉素的耐药率为2.1%;大肠埃希菌及克雷伯菌属对氨苄西林耐药率分别为85.1%、98.1%;革兰阴性杆菌对亚胺培南及美罗培南均敏感。结论儿科检出菌存在严重耐药问题,及时监测病原菌变化及耐药趋势以指导临床用药至关重要。

Variation of Pediatric Clinical Bacterial Isolates and Antibiotic Resistance in Hubei Area

OBJECTIVE To investigate the distribution of pediatric clinical bacterial isolates and the change in antibiotic resistance spectrum in Hubei area during 6 years. METHODS Data of bacterial susceptibility testing of clinical isolates from 15 tertiary hospitals in Hubei area from 1999 to 2004 were collected and analyzed by software WHONET-5. Results were assessed according to NCCLS 2002. RESULTS The amount of Gram-negative bacteria went down and of Gram-positive bacteria went up during this period. The proportion of coagulase-negative Staphylococcus (CNS) had been increasing and reached 32.4% in 2004. The proportions of Staphylococcus aureus decreased from 15.7% in 1999 to 7.4% in 2004. Escherichia were the second bacteria in the last two years. The drug resistance rate of staphylococci against penicillin and erythromycin was more than 94% and 58%, respectively. The oxacillin resistance rate of CNS was 74%, significantly higher than that of S. aureus (16.5%). Drug resistance rate of Enterococcus to vancomycin was 2.1%. Gram-negative bacteria were sensitive to meropenem and imipenem, whereas the resistance rate of Klebsiella and Escherichia to ampicillin was 98.1% and 85.1%, respectively. CONCLUSIONS The variation of drug resistance and distribution of pediatric clinical bacterial isolates are related to the improper use of antibiotics. It is very important to select antibiotics correctly according to the results of susceptibility tests.