2013-2015年我院儿童重症监护病房有创导管末端细菌培养及耐药性分析

目的:了解儿童重症监护病房(PICU)有创导管末端培养分离菌菌谱及耐药情况,为临床防治院内感染提供参考。方法:采用单中心回顾性研究方法对南京医科大学附属儿童医院PICU 2013-2015年所分离的气管插管、深静脉置管和导尿管等有创导管末端细菌菌株及耐药性进行调查分析。结果:3年共获得218例阳性培养标本,分离菌株256株,其中菌G-菌179株(69.92%),G+菌60株(23.44%),真菌17株(6.64%);前6位分离菌分别为鲍曼不动杆菌(32.42%)、肺炎克雷伯杆菌(17.58%)、粪肠球菌(4.69%)、白假丝酵母菌(4.30%)、铜绿假单胞菌(4.30%)和耐甲氧西林金黄色葡萄球菌(MRSA,3.91%)。体外药敏试验显示主要分离菌均呈多重耐药特性,对亚胺培南和第三代头孢菌素均显示高度耐药性;哌拉西林/他唑巴坦对铜绿假单胞菌具较强的抗菌活性,敏感率可达100.00%;仅有万古霉素和利奈唑烷对G+具有较强的抗菌活性,敏感率可达100.00%。结论:PICU有创导管末端培养分离菌以G-菌为主,细菌呈多重耐药特性。粪肠球菌和MRSA在G+菌中比例较高,应高度重视。

Bacterial Culture of Invasive Catheter Ends and Drug Resistance in Pediatric Intensive Care Unit of Our Hospital from 2013 to 2015

Objective:To investigate the bacterial culture spectrum of invasive catheter ends and drug resistance in pediatric intensive care unit(PICU),and to provide reference for clinical prevention and treatment of nosocomial infection.Methods:From 2013 to 2015,retrospective investigation was conducted on the isolated bacterial strains and drug resistance of invasive catheter ends such as endotracheal intubation,deep vein catheterization and urinary catheterization in PICU of the Children’s Hospital of Nanjing Medical University.Results:A total of 218 positive cultures were obtained in three years,and 256 strains were isolated.There were 179 strains of G-bacteria(69.92%),60 strains of G+bacteria(23.44%)and 17 strains of fungi(6.64%).The top six isolates were respectively Acinetobacter baumannii(32.42%),Klebsiella pneumoniae(17.58%),Enterococcus faecalis(4.69%),Candida albicans(4.30%),Pseudomonas aeruginosa(4.30%)and methicillin-resistant Staphylococcus aureus(MRSA,3.91%).In vitro drug susceptibility tests showed that the main isolates were multi-drug resistant and highly resistant to imipenem and third-generation cephalosporins.Piperacillin/tazobactam had strong antibacterial activity against P.aeruginosa,and the sensitivity rate was up to 100.00%.Only vancomycin and linezolidine had strong antibacterial activity against G+,and the sensitivity rate was up to 100.00%.Conclusion:In PICU,G-bacteria are the main isolates of bacterial culture of invasive catheter ends,and the bacteria are multi-drug resistant.E.faecalis and MRSA have higher proportion in G+bacteria and should be highly valued.