2012至2016年PICU脑脊液培养病原分布及耐药性分析

目的 了解PICU脑脊液培养病原学特征,探讨病原菌分布、耐药情况、感染来源和转归,为临床合理用药提供依据.方法 回顾性分析我院PICU 2012年1月至2016年12月脑脊液培养病原学及耐药情况.细菌鉴定和药敏试验采用法国生物梅里埃VITEK compatⅡ系统,部分菌株药敏试验采用纸片扩散法和E-test法.结果 982份脑脊液标本,培养阳性78例,阳性率7.9%,共分离出病原菌81株,革兰阴性菌46株(56.8%),革兰阳性菌35株(43.2%).排名前3位细菌依次为:鲍曼不动杆菌、凝固酶阴性葡萄球菌和大肠埃希菌,分别占28.4%、19.8 %和13.6%.病原菌对各种抗菌药物耐药性差异较大,表现为多重耐药或泛耐药,革兰阴性菌主要为鲍曼不动杆菌,对美罗培南、头孢菌素类耐药性高,对替加环素敏感性高.革兰阳性菌主要为凝固酶阴性葡萄球菌,对头孢唑林、氨苄西林耐药性高,对利奈唑胺、万古霉素敏感性高.结论 PICU脑脊液培养菌群中以革兰阴性菌为主,常见为鲍曼不动杆菌,对亚胺培南、头孢菌素类耐药性高.

Pathogens distribution of cerebrospinal fluid and antibiotic resistance analysis in pediatric intensive care unit from 2012 to 2016

Objective To investigate the composition of pathogens from cerebrospinal fluid culture in pediatric intensive care unit,and to explore the distribution of the pathogens,antibiotic resistance profile,infection source and prognosis.Methods The results of cerebrospinal fluid culture in pediatric intensive care unit from January 2012 to December 2016 were retrospectively analyzed.Bacteria identification and antimicrobial susceptibility were assayed by Vitek Compat Ⅱ system from Bio Mrieux Company.Some bacterial strains were tested by disk diffusion method or E-test.Results A total of 982 cerebrospinal fluid were tested during research period,and 78 were positive with positive rate of 7.9%.A total of 81 strains of pathogens were isolated,there were 46 strains of gram negative bacteria (56.8%) and 35 strains of gram positive bacteria (43.2%).The top three bacteria were Acinetobacter baumannii(28.4%),coagulase negative Staphylococcus(19.8%),and Escherichia coli(13.6%).The resistance to antibiotics was quite different,manifesting muti-resistance or extensively drug resistance.Acinetobacter baumannii was the predominant specy of gram negative bacteria,which was highly resistant to meropenem and cephalosporins and highly sensitive to tigecycline.Coagulase negative Staphylococcus was the predominant specy of gram positive bacteria,which was highly resistant to cefazolin and ampicillin and highly sensitive to linezolid and vancomycin.Conclusion Gram negative bacteria are the main species of cerebrospinal fluid culture in pediatric intensive care unit.Acinetobacter baumannii is the major pathogen,which was highly resistant to meropenem and cephalosporins.