7688份儿童血培养病原菌分布及耐药性分析

目的了解儿童感染血培养病原菌分布及耐药情况,为临床合理用药提供参考。方法采用BDBACTEC9240全自动血培养仪及其配套的树脂儿童血培养瓶对7 688份患儿送检血培养样本进行血培养,细菌鉴定采用VITEK-32全自动微生物分析仪,E-test法和纸片扩散法做药敏试验。结果 7 688份血培养中鉴定出病原菌741株,总阳性率为9.64%;检出病原菌中革兰阳性球菌占85.0%(630株)、革兰阴性菌占14.0%(104株),真菌占1.0%(7株);检出频次最高的5种病原菌分别为凝固酶阴性葡萄球菌属、肠球菌属、链球菌属、大肠埃希菌和肺炎克雷伯菌。凝固酶阴性葡萄球菌属对青霉素、苯唑西林、红霉素和苯唑西林-舒巴坦的敏感性低,未发现耐万古霉素的葡萄球菌及肠球菌。肠球菌属对呋喃妥因的敏感性较高。α溶血链球菌的药物敏感性比β溶血链球菌差。大肠埃希菌和肺炎克雷伯菌对第3、4代头孢菌素耐药率分别为33.3%和42.9%。结论凝固酶阴性葡萄球菌属是引起儿童菌血症和(或)败血症的首要病原菌,并且耐药率高,其治疗用药需参考药敏试验结果,合理选择使用抗菌药物。

Distribution and antibiotic resistance of isolates from 7 688 blood culture samples of children

Objective To analyze the distribution and antibiotic resistance of isolates from blood culture samples of children, and provide the reference for rational use of antibiotic. Methods A total of 7 688 blood culture samples of children were detected by BD BACTEC 9240 automatic blood cuhure system with pedsplus/f bottles. The positive blood culture samples were identified by VITEK-32 automatic microbiology system, and bacterial susceptibility testings were conducted on all isolates by E-test and disk diffusion method. Results There were 741 isolates identified：from 7 688 blood culture samples, and the total positive rate was 9.64%. The positive rates of gram-positive cocci, gram-negative bacilli and fungi were 85.0% （630 isolates） , 14.0% （ 104 isolates） and 1.0% （7 isolates）, respectively. The top 5 isolates with high detection frequency were eoagulase-negative Staphylococcus, Enterococcus, Streptococcus ~ Escherichia coli and KlebsieUa pneumoniae. Coagulase-negative Staphylococcus to penicillin, oxacillin, erythromycin and oxacillin / sulbactam had low sensitivity. Vancomycin-resistant Staphylococcus and Enterococcus were not found. The sensitivity of Enterococcus to nitrofurantoin was high. The sensitivity of alpha-hemolytic Streptococcus was lower than ＇that of beta-hemolytic Streptococcus. Escherichia coli and Klebsiella pneumoniae to 3,4-generation cephalosporin resistance rates were 33.3% and 42.9%. Conclusions Coagulase-negative Staphylococcus mainly causing children bacteremia and （or） septicemia was highly resistant to commonly used antibiotics, and more attention should be paid to the detection and rational use of antibiotic.