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1.
目的 了解我院儿童肺部感染病原菌分布及耐药性,指导早期经验性抗生素应用.方法 统计分析了2005年1月至2007年12月我院儿科181例住院患儿深部痰细菌培养结果.结果 符合条件的痰标本共分离细菌269株,其中革兰阴性菌占69.14%(186株),主要是大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷白杆菌,其对β内酰胺类抗生素有较高的耐药性,产超广谱β-内酰胺酶(ESBLs)的大肠埃希杆菌和肺炎克雷白杆菌的耐药性尤为突出,但对含β内酰胺酶抑制剂的头孢菌素和亚胺培南仍较敏感.革兰阳性菌占30.86%(83株),粪肠球菌、表皮葡萄球菌与金黄色葡萄球菌占革兰阳性球菌的前三位,除对万古霉素仍敏感外,金黄色葡萄球菌对头孢菌素以及氨基苷类抗生素的耐药率很高.结论 儿童深部痰培养分离菌株以革兰阴性菌为主,其耐药性较强,特别是产ESBLs的菌株对β内酰胺类抗生素的耐药性尤为突出.革兰阳性菌以葡萄球菌、粪肠球菌为主,其耐药率均较高.  相似文献   

2.
目的 对昆明地区急性下呼吸道感染(acute low respiratory infection,ALRI)患儿进行连续9年监测及临床研究,了解患儿细菌病原菌构成、变迁及对常用抗生素的耐药性.方法 对昆明市儿童医院2002年1月至2010年12月因ALRI住院的患儿痰液培养的致病菌株进行临床分析及研究,对分离菌株进行药敏试验.结果 病原菌构成情况:(1)病原菌总阳性率18.52% (3006/16 229),其中革兰阴性杆菌占75.35%,革兰阳性球菌占20.23%,真菌占4.42%;病原菌前5位依次为大肠埃希菌、肺炎克雷白杆菌、肺炎链球菌、流感嗜血杆菌、阴沟肠杆菌.(2)监护病房ALRI病原菌以革兰阴性菌为主,主要为大肠埃希菌、肺炎克雷白杆菌;革兰阳性菌以金黄色葡萄球菌为主.普通病房革兰阴性菌中,流感嗜血杆菌取代大肠埃希菌,成为最常见的病原菌,革兰阳性菌以肺炎链球菌为主.病原菌的耐药情况:后4年与前5年比较,病原菌总体耐药情况呈上升趋势,部分达90%左右,并呈多重耐药状态;未发现对亚胺培南及万古霉素耐药的菌株;大肠埃希菌和肺炎克雷白杆菌产超广谱β-内酰胺酶菌株检出率呈上升趋势.结论 昆明地区9年间小儿ALRI细菌病原菌以革兰阴性杆菌为主,其中大肠埃希菌为首位;不同病房病原构成、变迁均不同;病原菌总体耐药情况呈上升趋势.  相似文献   

3.
目的了解小儿败血症的致病菌对不同抗菌药物的敏感及耐药情况,为合理使用抗菌药物提供依据。方法对238例小儿败血症的临床表现,血培养及药敏试验结果进行统计分析。结果238例中革兰阳性球菌194例,以凝固酶阴性葡萄球菌(CNS)占优势,其次是金黄色葡萄球菌。革兰阳性菌44例,以大肠埃希菌居多,棒状及肺炎克雷伯杆菌次之。革兰阳性球菌对头孢唑啉、万古霉素等敏感性较高,革兰阴性菌克雷伯及大肠埃希杆菌对美洛培南、磷霉素等敏感性较高。结论CNS为小儿败血症的主要致病菌,其次为金黄色葡萄球菌、大肠埃希菌及肺炎克雷伯杆菌等。对常用的抗菌药物有不同程度的耐药性,提示要合理使用抗菌药物。  相似文献   

4.
新生儿泌尿系统感染41例临床分析   总被引:1,自引:0,他引:1  
目的 探讨新生儿泌尿系感染的临床特点及其致病菌的分布和耐药情况,为临床诊断治疗提供依据。方法 对2002—2004年NICU收治的41例泌尿系感染新生儿的临床特点及其尿培养、药敏试验结果进行同顾性分析。结果 41例泌尿系感染新生儿中有泌尿道感染症状者4.9%(2例),黄疸60.1%(25例),发热53.7%(22例),腹泻26.8%(11例),体重不增9.8%(4例)。尿培养阳性73.2%(30例),其中大肠埃希菌14例,占46.7%;肺炎克雷伯菌7例,占23.3%;产气肠杆菌2例,占6.7%;阴沟杆菌1例,占3.3%;鹑鸡肠球菌2例,占6.7%;屎肠球菌1例,占3.3%;粪肠球菌1例,占3.3%;另有2例系大肠埃希菌分别并鹑鸡肠球菌和屎肠球菌混合感染。在全部16例大肠埃希菌中产超广谱13.内酰胺酶(ESBL)菌(+)2例,占12.5%。药物敏感试验中,肠杆菌对美平、阿米卡星、环丙沙星、呋哺坦丁、头孢曲松、头孢噻肟钠敏感;肠球菌对万古霉素、利福平、环丙沙星、氯霉素、呋哺坦丁敏感;两者对氨苄青霉素均耐药。结论新生儿泌尿系感染临床表现不典型,多以全身症状为主,主要致病菌仍以大肠埃希菌为主,ESBL(+)检出率有上升,主要致病菌对氨苄青霉素普遍耐药,经验用药不可取。  相似文献   

5.
目的:分析新生儿重症监护室(NICU)新生儿泌尿系感染(UTI)的临床特点、病原体分布、病原体药敏及治疗效果。方法:回顾性分析NICU 229例新生儿UTI患儿的临床资料。结果:新生儿UTI临床表现主要为发热或者体温不规则、吃奶少或者拒奶、黄疸不退、呕吐、腹泻、体重不增、精神萎靡等。居于前三位的病原体主要为大肠埃希氏菌、屎肠球菌、肺炎克雷伯杆菌。大肠埃希菌和肺炎克雷伯杆菌对氨苄西林及大部分头孢类药物具有较强的耐药性(≥85%),而对亚胺培南、美罗培南100%敏感,其次对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦也有很高的敏感性(>90%);屎肠球菌对青霉素(100%)、利福平(84%)、庆大霉素(79%)的耐药率高,对万古霉素最敏感。结论:新生儿UTI临床表现不典型,多以全身症状为主;主要致病菌以大肠埃希菌为主,但屎肠球菌检出率及耐药率均较高,主要致病菌对大部分青霉素及头孢类耐药,临床医生应参考药敏试验结果决定临床用药。  相似文献   

6.
目的:探讨肾病综合征(NS)合并尿路感染(UTI)患儿的菌群分布及其药物敏感性特点,指导临床合理应用抗生素。方法:对2011年1~12月住院的97例NS合并UTI患儿(初发53例,复发44例)的病原菌分布特点及其药敏情况进行回顾性分析。结果:NS患儿合并UTI的发生率为36.5%,其中NS复发患儿UTI的发生率高于初发者(44.0% vs 31.9%,P<0.05),临床表现以无症状菌尿为主。病原菌分析示肠球菌比例最高(50.5%),其中屎肠球菌29.4%,粪肠球菌21.1%。其次为革兰阴性菌大肠埃希菌(15.6%)、肺炎克雷伯菌(14.7%)。肠球菌对呋喃妥因、万古霉素及利奈唑胺的敏感性较高,对四环素、莫西沙星耐药率高;屎肠球菌和粪肠球菌多重耐药菌株的检出率分别为72%和17%(P<0.05)。大肠埃希菌、肺炎克雷伯菌对丁胺卡那霉素、亚胺培南、哌拉西林/他唑巴坦敏感性较高。产超广谱β-内酰胺酶(ESBLs)革兰阴性菌的检出率为25%,产ESBLs革兰阴性菌对亚胺培南、丁胺卡那霉素及哌拉西林/他唑巴坦的敏感性为100%,对氨苄西林、头孢唑林及头孢曲松几乎无敏感性。结论:复发NS患儿较初发者更易发生UTI;肠球菌已成为NS患儿合并UTI的主要致病菌,且耐药现象严重,其中屎肠球菌多呈多重耐药。  相似文献   

7.
新生儿下呼吸道感染病原学及耐药性检测   总被引:2,自引:0,他引:2  
目的:调查该院新生儿重症监护病房(NICU)下呼吸道感染的病原菌及其耐药性。方法:对2005年1月至2006年12月该院NICU 1 173例下呼吸道感染新生儿的痰液标本经分离培养,做菌株鉴定和药敏试验。结果:共分离培养出病原菌707株,阳性率为60.3%。其中革兰阴性菌521株,占73.7%;革兰阳性菌106株,占15.0%;真菌80株,占11.3%。革兰阴性菌以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和肠杆菌为主,较敏感的抗生素为亚胺培南、环丙沙星、第四代头孢菌素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、丁胺卡那霉素,肠杆菌的敏感谱与之相似,但敏感率较低。革兰阳性菌中以金黄色葡萄球菌和其他凝固酶阴性的葡萄球菌(CNS)为主。金黄色葡萄球菌和其他CNS对青霉素的耐药率达到100%,对万古霉素、环丙沙星和哌拉西林/他唑巴坦敏感。结论: 该院NICU下呼吸道感染的病原菌以革兰阴性菌为主, 大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主要病原菌。  相似文献   

8.
目的 探讨新生儿重症监护病房细菌感染及其对抗生素的耐药情况.方法 对646株培养阳性菌株以VITEK全自动微生物分析仪进行菌株鉴定及药敏试验.结果 646株培养阳性标本中,革兰阴性菌380株,占58.8%,革兰阳性菌254株,占39.3%.革兰阴性杆菌以肺炎克雷白杆菌最常见,其次为大肠埃希菌;革兰阳性菌以金黄色葡萄球菌最常见.产ESBL阳性菌株73株,包括肺炎克雷白杆菌50株,大肠杆菌23株.常见革兰阴性细菌对氨苄西林、头孢曲松、头孢唑啉耐药率高,对头孢吡肟、头孢他啶、亚胺培南、哌拉西林/他唑巴坦的耐药率低.ESBL阳性肺炎克雷白杆菌及大肠埃希菌对氨苄西林、头孢菌素类耐药显著高于亚胺培南及哌拉西林/他唑巴坦(P<0.01).常见革兰阳性细菌对青霉素耐药率高达74.6%~ 91.7%,耐甲氧西林金黄色葡萄球菌对氨苄西林/舒巴坦、红霉素、亚胺培南、苯唑西林、青霉素耐药率均高,达80% ~ 100%,目前未发现耐万古霉素、利奈唑胺革兰阳性细菌.结论 我院新生儿重症监护病房细菌以肺炎克雷白杆菌、金黄色葡萄球菌、大肠埃希菌最常见,对常用抗生素的耐药现象需重视,尤其ESBL阳性细菌及耐甲氧西林金黄色葡萄球菌耐药现象更严重,应尽早根据药敏试验调整抗生素.  相似文献   

9.
目的 了解昆明地区近5年小儿尿路感染常见病原菌分布及其耐药情况.方法 对2003年1月 - 2007年12月收治的116例尿培养阳性患儿病原菌构成比及耐药性进行分析总结.结果 116株细菌中,革兰阴性杆菌占81.89%(95株),革兰阳性球菌占18.11%(21株).前三位致病菌分别为大肠埃希菌67.24%、屎肠球菌12.93%、肺炎克雷伯菌8.62%.产超广谱β内酰胺酶(ESBLs)情况:大肠埃希菌产酶49株,产酶率62.82%,肺炎克雷伯氏菌产酶4株,产酶率40%.大肠埃希菌对抗生素的敏感性依次为头孢哌酮/舒巴坦、氨苄西林/舒巴坦、头孢吡肟、头孢他啶;对头孢唑啉、头孢噻肟、头孢哌酮、头孢曲松耐药性均在90%以上;对氨苄西林、哌拉西林100%耐药.屎肠球菌对青霉素、红霉素100%耐药,对万古霉素100%敏感.大肠埃希菌产ESBLs株较非产ESBLs株对大部分抗菌药的耐药性明显增高.亚胺培南对革兰阴性杆菌100%敏感,呋喃妥因敏感性在90%以上.结论 昆明地区小儿尿路感染病原菌以大肠杆菌为主,大肠杆菌耐药性明显.治疗前的尿培养值得临床重视.  相似文献   

10.
目的 研究新生儿重症监护室(neonatal intensive care unit,NICU)血培养阳性的脓毒症患儿的病原菌分布及耐药情况,为临床合理使用抗生素提供依据.方法 回顾性分析2009年1月至2011年7月广东医学院附属医院NICU 1450例新生儿的1450份血培养结果及药敏结果.结果 1450份血培养标本共分离病原菌9种233株,总阳性率为16.1%.其中革兰阳性球菌93株,以凝固酶阴性葡萄球菌占优势,其次为金黄色葡萄球菌;革兰阴性杆菌103株,以肺炎克雷白杆菌居多,其次为大肠埃希菌、鲍曼不动杆菌;真菌37株,以念珠菌为主.革兰阳性球菌对万古霉素、利奈唑胺及替考拉宁敏感性高,对青霉素、苯唑西林及β-内酰胺酶抗生素耐药性达95%以上;革兰阴性杆菌对左氧氟沙星、亚胺培南及美罗培南敏感;真菌以念珠菌为主,对抗真菌药物普遍敏感.结论 凝固酶阴性葡萄球菌、肺炎克雷白杆菌、大肠埃希菌等是NICU中新生儿脓毒症最常见的几种病原菌,耐药性高,临床医生应根据细菌鉴定及药敏试验选择敏感药物治疗,且真菌感染不可忽视,值得关注.  相似文献   

11.
Nosocomial blood stream infections continue to be a cause of high mortality and morbidity in newborn intensive care units (NICUs). Identification of the causative microorganisms and their antimicrobial sensitivities will guide the selection of appropriate empirical treatment. We prospectively evaluated culture-proven nosocomial sepsis cases and antibiotic sensitivity patterns seen in the NICU of Dr. Sami Ulus Children's Hospital, in Ankara, Turkey during a six-year period (2000-2006). A total of 106 nosocomial sepsis attacks were found in 100 patients, with 72 of them preterm. Gram-negative bacteria were isolated at a rate of 70.8%, gram-positive at 22.6% and Candida species (spp.) at 6.6%. The most commonly isolated microorganisms were, in order of frequency, Klebsiella spp. (39.6%), Pseudomonas aeruginosa (11.3%) and Coagulase-negative staphylococci (9.4%). During the study, 12 of the 28 term babies (42.9%) and 26 of the 72 preterm babies (36.1%) died due to nosocomial sepsis, with a mortality rate of 38%. Resistance to ampicillin was 100%, to cefotaxime 88%, to gentamicin 73%, and to amikacin 23% in gram-negative bacteria. No carbapenem resistance was found except for P. aeruginosa (25%). Resistance to penicillin was 100% and clindamycin 58.3% in gram-positive bacteria. No glycopeptide or carbapenem resistance was found. In conclusion, nosocomial sepsis still has a high mortality rate. Gram-negative bacteria were the most commonly isolated microorganisms with Klebsiella spp. being dominant. All gram-negative species were resistant to ampicillin, and all gram-positive bacteria were resistant to penicillin. No glycopeptide or carbapenem resistance was found in gram-positive bacteria. In gram-negative bacteria, low amikacin and high gentamicin and cephalosporin resistances were found. No carbapenem resistance was found except for P. aeruginosa. Restricted and alternate antibiotic usage policies seem important for the resistance problem.  相似文献   

12.
目的调查分析早产儿医院感染败血症的临床特点、病原菌分布及药敏情况。方法回顾性分析我院新生儿科2007年1月至2011年12月发生医院感染败血症的早产儿病例。结果研究期间共出院早产儿5660例,排除染色体异常和住院时间小于5天的病例,纳入分析5392例,发生医院感染败血症81例,发生率1.5%,共治愈60例,治愈率74.1%。发病时表现多种多样,最常见的实验室指标异常是C反应蛋白(CRP)升高。病原菌以革兰阴性菌最多见(57.6%),真菌占第二位(30.3%)。其中,革兰阴性杆菌以肺炎克雷伯菌为主,对大部分β内酰胺类抗生素耐药;革兰阳性菌以表皮葡萄球菌为主,大多对青霉素耐药,对万古霉素敏感;真菌感染均为念珠菌,对氟康唑、两性霉素B均敏感。结论早产儿医院感染败血症临床表现各异,CRP升高是较敏感的指标。致病菌主要为革兰阴性菌和真菌,革兰阴性菌对大部分β-内酰胺类抗生素耐药。  相似文献   

13.
新生儿重症监护病房血培养252株病原菌分布及耐药性分析   总被引:12,自引:1,他引:12  
目的 研究新生儿重症监护病房 (NICU)败血症和菌血症的病原菌分布及其耐药情况 ,为合理使用抗生素提供依据。方法 对 2 0 0 0年 1月至 2 0 0 3年 8月广州市儿童医院NICU中 10 90例新生儿的 10 90份血标本进行培养、分离、鉴定及药敏分析。结果  10 90份血标本培养共分离病原菌 15种 2 5 2株 ,总阳性率为 2 3 1%。其中革兰阳性球菌 2 12株 ,以凝固酶阴性葡萄球菌占优势 ,其次为金黄色葡萄球菌 ;革兰阴性杆菌 38株 ,以大肠埃希菌居多 ,肺炎克雷伯杆菌次之。革兰阳性球菌对万古霉素、替考拉宁、头孢哌酮 /舒巴坦、克林霉素等的敏感性较高 ;革兰阴性杆菌对亚胺培南、头孢哌酮 /舒巴坦、羟氨苄 /克拉维酸具有很高的敏感性。结论 凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌等是NICU中新生儿败血症 /菌血症最常见的几种病原菌 ,对常用的抗菌药物有程度不同的耐药性。  相似文献   

14.
Septicemia continues to be an important cause of neonatal morbidity and mortality. The bacteria most commonly responsible are group B beta-hemolytic streptococci and Escherichia coli, but regional differences exist. Recently sepsis caused by Staphylococcus epidermidis has occurred with increasing frequency in several neonatal intensive care units. Other organisms are less commonly responsible. The choice of antibiotics for suspected sepsis is based on the possible organisms involved and their antibiotic susceptibility patterns, which vary from hospital to hospital and at different times in the same hospital. Currently recommended initial therapy consists of a penicillin and an aminoglycoside, usually ampicillin and gentamicin. The addition of vancomycin is indicated when staphylococcal septicemia is suspected. During outbreaks of neonatal sepsis caused by aminoglycoside-resistant gram-negative bacteria, the use of third-generation cephalosporins or acylaminopenicillins may be appropriate, depending on the results of susceptibility tests. Continuing efforts to develop antibiotics for the treatment of neonatal sepsis are warranted.  相似文献   

15.
贵阳市893例小儿下呼吸道感染的细菌及药敏分析   总被引:3,自引:2,他引:1  
目的:调查贵阳市小儿下呼吸道感染(LRI)中的细菌及其耐药性,以指导临床合理用药。方法:收集2006年8月至2008年6月我院893 例LRI住院患儿的咽喉深部痰液标本进行细菌培养及药敏试验。结果:明确有细菌感染的为543例,阳性率为60.8%。分离出30种细菌,共计598株,其中革兰阴性杆菌533株(89.1%),革兰阳性球菌57株(9.8%)。革兰阴性菌以大肠埃希菌、肺炎克雷伯菌为主。大肠埃希菌及肺炎克雷伯菌对哌拉西林/他唑巴坦、丁胺卡那、环丙沙星、左氧氟沙星敏感,对亚胺培南高度敏感。革兰阳性球菌中以肺炎链球菌和葡萄球菌为主,肺炎链球菌对青霉素及头孢唑啉钠敏感,而葡萄球菌则对青霉素及头孢唑啉钠耐药率高,两种革兰阳性球菌均对万古霉素高度敏感,对罗红霉素耐药率高。结论:贵阳市小儿LRI的主要病原菌为革兰阴性杆菌,其中尤以大肠埃希氏菌、肺炎克雷伯菌多见,不同菌种对抗生素药物敏感性和耐药性均存在差异。应根据药敏试验合理选用抗生素治疗。[中国当代儿科杂志,2009,11(12):964-966]  相似文献   

16.
??Objective To analyse the pathogen distribution and drug resistance status in 268 cases of neonatal sepsis. Methods Totally 268 cases of neonatal sepsis were chosen who had been hospitalized between 2010 and 2015 with blood culture being positive. They were divided into early-onset and late-onset sepsis groups and their clinical characteristics??pathogen distribution and drug resistance were explored. Results The gram-negative bacteria were the major pathogens early-onset sepsis group??58.3%????in which escherichia coli was 31.2% and klebsiella pneumoniae was 23.9%. Gram-positive bacteria were the major pathogen in late-onset sepsis group??65.1%????in which coagulase negative staphylococcus was 46.5% and excrement enterococcus was 11.6%. Gram-positive bacteria were sensitive to vancomycin with durg resistance rate ??90% to penicillin????80% to erythromycin????60% to clindamycin??ampicillin and cefazolin . Gram-negative bacteria were sensitive to meropenem. Gram-negative bacteria showed high resistance to ampicillin??piperacillin and cefotaxime??but low resistance to ceftazidime and cefoperazone. Conclusion The common pathogens and clinical characteristics are different in the early-onset and late-onset sepsis groups. It is important to choose reasonable antibiotic drugs and strengthen drug resistance surveillance.  相似文献   

17.
BACKGROUND: The most common oral antibiotics used in the treatment of urinary tract infection (UTI) are sulphonamides and cephalosporins, but emerging resistance is not unusual. AIMS: To assess the change in susceptibility of urinary pathogens to oral antibiotics during the past decade in children with community acquired UTI. METHODS: The study sample included two groups of children with a first community acquired UTI: 142 children enrolled in 1991 and 124 enrolled in 1999. UTI was diagnosed by properly collected urine specimen (suprapubic aspiration, transurethral catheterisation, or midstream specimen in circumcised males) in symptomatic patients. Antimicrobial susceptibility of the isolates was compared between the two groups. RESULTS: The pathogens recovered in the two groups were similar: in 1991--E coli 86%, Klebsiella 6%, others 8%; in 1999--E coli 82%, Klebsiella 13%, and others 5%. A slight but generalised decrease in bacterial susceptibility to common antibiotics in the two groups was shown: ampicillin 35% versus 30%; cephalexin 82% versus 63% (p < 0.001); nitrofurantoin 93% versus 92%. The only exception was co-trimoxazole, 60% versus 69%. Overall resistance to antibiotics in 1999 was as follows: ampicillin 70%, cephalexin 37%, co-trimoxazole 31%, amoxicillin-clavulanate 24%, nitrofurantoin 8%, cefuroxime-axetil 5%, nalidixic acid 3%. CONCLUSIONS: This study shows a slight but generalised decrease in bacterial susceptibility to common oral antibiotics in the past decade in our population. Empirical initial treatment with co-trimoxazole or cephalexin is inadequate in approximately one third of UTI cases. A larger number of pathogens may be empirically treated with amoxicillin-clavulanate (24% resistance); 95% of organisms are susceptible to cefuroxime-axetil.  相似文献   

18.
目的分析新生儿重症监护室(NICU)中肺炎克雷伯菌败血症的危险因素和临床特征,做到早期诊断和合理治疗。方法对我院NICU 2005年1月至2008年5月期间16例确诊为肺炎克雷伯菌败血症患儿的临床资料和药敏结果进行回顾性分析,并与同期32例非败血症患儿和33例其他病原体所致败血症患儿进行比较。结果低出生体质量、外周静脉中心静脉置管(PICC)、先期使用3代头孢菌素为肺炎克雷伯菌败血症的危险因素,所有病例均属于医院获得性感染,全部发生在早产儿,81.2%是极低出生体重儿;若同时合并其他致病菌感染预后差;肺炎克雷伯菌93%为产β内酰胺酶(ESBL)菌株,100%对亚胺培南类药物敏感,对常用头孢类药物不敏感。结论肺炎克雷伯菌已成为NICU中败血症的主要致病茵,而且多为医院感染。与早产低出生体质量、PICC、先期使用3代头孢菌素有关,耐药性强,碳青霉烯类是敏感药物。  相似文献   

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