儿童重症监护室多重耐药菌主动筛查分布分析

目的分析儿童重症监护室多重耐药菌定植情况及其相关因素。方法用快速显色培养基筛查患儿鼻咽拭子、肛拭子标本，筛查超广谱β-内酰胺酶(ESBL)的肠杆菌和耐药金黄色葡萄球菌(MRSA)，比较新生儿科、儿科、小儿外科重症监护室新入院患儿不同性别、年龄、标本采集时间、病种、感染情况、感染部位及病种的ESBL和MRSA主动筛查阳性率。结果ESBL及MRSA 主动筛查例数及阳性率分别为2 049例（48.5%）及1 923例（8.8%）；男女患儿间ESBL及MRSA阳性率差异无统计学意义（P>0.05）。各年龄段患儿ESBL与MRSA阳性检出率间的总差异有统计学意义（P<0.05）;其中围产期新生儿ESBL及MRSA筛查阳性率较非围产期新生儿低;3个月内小婴儿ESBL筛查阳性率较新生儿显著升高，余各年龄分段间的差异无统计学意义（P>0.05）。两种筛查的阳性率在春夏秋冬四季的差异有统计学意义（P<0.05），两两比较后ESBL阳性率在夏季及冬季较春季高;冬季较春季、夏季、秋季MRSA阳性率高。儿科阳性率较新生儿科、小儿外科高;感染性疾病患儿较非感染性疾病患儿两种主动筛查阳性率显著升高，其中呼吸道感染较肠道感染患儿ESBL阳性率高;MRSA阳性率在各感染部位的差异无统计学意义（P>0.05）。非感染性疾病的新生儿中，高胆红素血症两种检验阳性率均较高;患儿二次住院ESBL阳性率高于首次检查阳性率。结论本院各儿童重症监护室的多重耐药筛查阳性率以小婴儿、夏季及冬季、感染性疾病、呼吸道感染、高胆红素血症等因素的患儿较高，本研究可为探索多重耐药机制及早期发现筛选高危宿主和制定相应对策提供本底资料。

The analysis of multidrug-resistant bacteria tested in pediatric intensive care unit

Objective To analysis the situation and risk factors of the colonization of multi-drug resistant bacteria screening in pediatric intensive care unit (PICU). Methods Fast colorimetric medium were used to test nasopharyngeal swabs and anal swabs to screen Enterobacteriaceae and resistant Staphylococcus aureus (MRSA) with extended spectrum β-lactamases (ESBL) test. The positive rates of MRSA and ESBL among different gender, age, specimen collection time, disease type, and infection parts, in neonatal, pediatric and pediatric surgical intensive care units were analyzed. Results It is showed that the number of enrolled patients and the positive rates of ESBL and MRSA active screening were 2094, 48.5% and 1923, 8.8%, respectively. Positive rates of ESBL and MRSA active screening were significantly different and with poor consistency. There was no significant difference in the positive rate between boys and girls. The total difference between the positive rate of ESBL and MRSA in children of all ages was statistically significant. Among them, the positive rates of ESBL and MRSA screening in newborns during perinatal period were lower than those in non-perinatal newborns. The positive rate of ESBL screening in small infants was significantly higher than that of neonates within 3 months. There was no significant difference among other age groups. There was a linear trend between the detection rate and the age of children.The positive rates of the two kinds of screening among spring, summer, autumn, and winter were statistically different. The positive rates of ESBLs in pair were higher in summer than those in spring, summer and winter. The positive rates of ESBLs in spring were higher than those in spring and summer. Results of ESBL and MRSA active screening in pediatric, neonatal and pediatric surgery were significantly different. The positive rates of ESBL and MRSA in children with infectious diseases were significantly higher than those in non-infectious diseases. The positive rate of ESBL in children with respiratory infections was higher than that in children with intestinal infections. Among newborns classified as non-infectious diseases, the positive rates of ESBL and MRSA in children with hyperbilirubinemia were higher. Secondary hospitalization had showed higher positive rate than that of initial examination. Conclusion The multi-drug resistance screen positive rate of PICU is high in small infants, in summer or winter, with infectious disease,respiratory infections and hyperbilirubinemia.