儿科重症监护病房患儿血培养病原菌分布及其耐药性

目的了解儿科重症监护病房(PICU)患儿血培养分离病原菌及其耐药性,为重症患儿血流感染的经验性治疗提供参考依据。方法对该院2011—2015年PICU患儿血培养标本分离的病原菌进行鉴定及药敏分析。结果 3 215份血标本分离病原菌180株,阳性率为5.60%,其中革兰阳性菌153株(85.00%),革兰阴性菌27株(15.00%)。排名前5位的病原菌依次为表皮葡萄球菌、人葡萄球菌、溶血葡萄球菌、大肠埃希菌及金黄色葡萄球菌,分别占26.67%、25.00%、11.66%、5.55%和3.89%。葡萄球菌属细菌对利奈唑胺、万古霉素及奎奴普丁/达福普汀耐药率均为0;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为70.18%、42.86%;大肠埃希菌仅对氨苄西林、头孢唑林、头孢曲松、庆大霉素及复方磺胺甲口恶唑耐药率较高(50.00%~80.00%)。结论 PICU患儿血培养病原菌以凝固酶阴性葡萄球菌(CNS)和大肠埃希菌为主,不同种类CNS的耐药率存在一定差异。

Distribution and antimicrobial resistance of pathogens isolated from blood culture of children in a pediatric intensive care unit

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture of children in a pediatric intensive care unit (PICU), provide reference for empirical treatment of bloodstream infection in critically ill children.MethodsPathogenic bacteria isolated from blood culture of children in a PICU in 2011-2015 were identified and performed antimicrobial susceptibility testing.ResultsA total of 180 strains of pathogens were isolated from 3 215 blood specimens, the positive rate was 5.60%, 153（85.00%） of which were gram positive bacteria and 27（15.00%） were gram negative bacteria. The top five isolated pathogens were Staphylococcus epidermidis(26.67%)， Staphylococcus hominis(25.00%)，Staphylococcus haemolyticus(11.66%)， Escherichia coli(5.55%)，and Staphylococcus aureus(3.89%). The resistance rates of Staphylococcus spp. to linezolid, vancomycin, and quinupristin/dalfopristin were all 0; the detection rates of methicillin resistant coagulase negative staphylococci (MRCNS) and methicillin resistant Staphylococcus aureus(MRSA) were 70.18% and 42.68% respectively； Escherichia coli had high resistance rates to ampicillin， cefazolin， ceftriaxone， gentamycin, and compound sulfamethoxazole（50.00%-80.00％）.ConclusionCNS and Escherichia coli are the main pathogens in blood culture of children in PICU, differences in antimicrobial resistance exist among different types of CNS.