儿童血液病患者血培养分离病原菌分布及耐药性分析

目的 了解医院儿童血液病患者血培养阳性分离病原菌分布和耐药性,为临床合理用药提供实验室依据.方法 对2009年1月-2011年9月医院儿科送检的血液或骨髓标本,使用BACTEC-9240全自动血培养仪培养,用VITEK-2全自动微生物鉴定系统进行菌种鉴定和药敏试验.结果 血培养标本阳性率为11.97％,其中革兰阳性菌53.28％,革兰阴性菌43.17％,真菌3.55％;革兰阳性菌对替考拉宁耐药率＜10.00％,万古霉素、利奈唑胺、喹奴普汀/达福普汀及替加环素未发现耐药株;革兰阴性菌对三、四代头孢菌素及单环类中除头孢曲松(对大肠埃希菌、铜绿假单胞菌)外,耐药率＜24.4％,未发现碳青霉烯类耐药株.结论 医院儿科患者血培养阳性分离菌株以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、表皮葡萄球菌、人葡萄球菌及缓症链球菌为主,对革兰阳性菌的感染首选替考拉宁、万古霉素、利奈唑胺、喹奴普汀/达福普汀及替加环素;对革兰阴性菌的感染首选三、四代头孢菌素、单环类及碳青霉烯类.

Pathogens cultured from blood of children with hematopathy and drug resistance

OBJECTIVE To investigate the distribution and drug resistance of isolates in blood culture of children with hematopathy in pediatrics in our hospital and supply the basis of the rational use of antibiotics.METHODS Blood or marrow samples from pediatrics from Jan 2009 to Sept 2011 were cultured with BACTEC-9240 instrument and VITEK-2 system was used to detect the bacteria and perform the drug susceptibility testing.RESULTS The isolation rate of blood culture was 11.97%,the gram-positive bacteria accounted for 53.28%,the gram-negative bacteria accounted for 43.17%,the fungi accounted for 3.55%.The resistance rates of the gram-positive bacteria against teicoplanin were less than 10%,there were no gram-positive bacteria strains resistant to vancomycin,linezolid,quinupristin/dalfopristin,and tigecycline;the resistance rates of gram-negative bacteria against the third or fourth generation cephalosporins,monobactams were less than 24.4%,(except the resistance rate of Escherichia coli,Pseudomonas aeruginosa),there were no gram-negative bacteria resistant to carbapenems.CONCLUSION The main isolates of blood culture in pediatrics in our hospital are Escherichia coli,Staphylococcus epidemidis,S.homonis,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Streptococcus mitis;teicoplanin,vancomycin,linezolid,quinupristin/dalfopristin,tigecycline should be regarded as the first-line antibiotics against the gram-positive bacteria;the third or fourth generation cephalosporins,monobactams should be regarded as the first-line antibiotics against the gram-negative bacteria.