儿童阴沟肠杆菌感染临床分布及耐药性变迁

目的 分析了解2008-2010年儿童感染阴沟肠杆菌临床分布及耐药变迁,以指导临床合理使用抗菌药物.方法 采用K-B法进行药物敏感试验,按CLSI折点判读其结果,使用x2检验分析3年阴沟肠杆菌耐药性变化.结果 650株阴沟肠杆菌对多种抗菌药物具有耐药性,3年耐药率监测结果显示,美洛西林分别为25.4％、33.3％、41.7％,头孢他啶12.9％、18.2％、25.5％,头孢噻肟22.5％、31.6％、45.8％,头孢曲松38.8％、44.5％、48.6％,均呈逐年上升趋势,差异有统计学意义(P＜0.05),2010年头孢吡肟、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率也明显高于前两年,其耐药率分别为9.3％、11.1％、15.3％,差异有统计学意义(P＜0.01).结论 儿童感染阴沟肠杆菌其耐药率呈逐年增长,对儿童这一特殊群体临床选择抗菌药物更应该遵循最快控制感染、最小不良反应、最低诱导耐药的原则,以减少耐药菌株的产生和传播,预防和控制医院感染暴发流行.

Clinical distribution of Enterobacter cloacaeinfections in children and change of drug resistance

OBJECTIVE To analyze the clinical distribution of Enterobacter cloacae causing infections in children from 2008 to 2010 and the change of its drug resistance so as to guide the reasonable clinical use of antibiotics.METHODS Antimicrobial susceptibility testing was performed by K-B method and the standards of CLSI were used to assess the results of antimicrobial susceptibility testing.χ2 test was used to analyze the change of drug resistance of Enterobacter cloacae isolated in the past three years.RESULTS Totally 650 strains of E.cloacae had multidrug resistance.The surveillance for drug resistance rates revealed that the resistance rates to mezlocillin were 25.4%,33.3%,41.7% in 2008,2009 and 2010,respectively;those to ceftazidime were 12.9%,18.2%,25.5% respectively;those to cefotaxime were 22.5%,31.6% and 45.8% respectively;those to ceftriaxone were 38.8%,44.5%,48.6% respectively,presenting an upward trend,the differences were statistically significant(P<0.05).The drug resistant rates to cefepime,cefoperazone/sulbactum,piperacillin/tazolebactum in 2010 were significantly higher than those of the past two years,which were 9.3%,11.1%,15.3%,respectively(P<0.01).CONCLUSION The drug resistance rate of E.cloacae isolated from children shows a year by year increasing trend;for children,the application of the antibiotics must follow the principles of prompt infection control,minimum induced resistance and minimum side effects so as to reduce the induction and spread of drug resistant strains,prevent and control the outbreak of nosocomial infections.