儿科院内临床常见细菌耐药性监测

目的调查儿科临床常见致病菌的耐药性现状。方法药物敏感性试验采用Kirby-Bauer纸片扩散法(苛养菌用浓度梯度法),耐药性数据分析采用WHONET5软件。结果2002年1月~2003年12月共收集儿科医院患者首次分离2 303株,其中革兰阳性菌占29.7%,革兰阴性菌占70.3%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS),分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的9.7%与67.6%,无万古霉素耐药株;肠球菌耐万古霉素株4.1%;11.9%的肺炎链球菌对青霉素耐药;肠杆菌科细菌对亚胺培南的耐药率最低;产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌株的检出率分别为49.7%和63.1%。结论细菌耐药性仍是目前临床上的严重问题,应重视开展儿科抗感染治疗中耐药性监测工作,同时合理使用抗菌药物以降低耐药性和采取有效措施控制其传播也是非常重要的。

Surveillance of Antimicrobial Resistance of Clinical Bacteria in Pediatric Hospital

OBJECTIVE To investigate the bacterial resistance of clinical isolates from pediatric hospital for the guidance of rational use of antibiotics.METHODS Disc diffusion test(Kirby-Bauer method) was used to study the antimicrobial resistance(fastidious bacteria were detected by E test).WHONET5 was applied for analysis.(RESULTS) In the period of study from 2002 to 2003,2 303 strains which were the first isolated from each patient were collected.Of 2 303 clinical isolates,Gram positive organisms accounted for 29.7%,Gram negative ones for 70.3%.Escherichia coli,Klebsiella spp,Staphylococcus aureus,coagulase-negative staphylococci and Pseudomonas aeruginosa were the most common strains among the isolates.Meticillin-resistant S.aureus(MRSA) and meticillin-resistant coagulase(-negative) staphylococci(MRCNS) accounted for 9.7% and 67.6% of S.aureus and coagulase-negative(staphylococci),respectively.Resistant rates of MRSA and MRCNS were higher than that of meticillin-susceptible S.aureus(MSSA) and meticillin-susceptible coagulase-negative staphylococci(MSCNS) to antimicrobial agents commonly used in clinic.No vancomycin resistant strains of staphylococci were found. 4.1% of Enterococcus spp were vancomycin resistant strains.Resistant rate of Streptococcus pneumoniae was 11.9% to penicillin. Most of isolates of Enterobacteriaceae were susceptible to imipenem.The incidences of E.coli and Klebsiella spp producing extended spectrum beta-lactamases(ESBLs) isolates were 49.7% and 63.1%,respectively.The resistance rates of(ESBLs) producing strains to antimicrobial agents(except carbapenems) were higher than those of ESBLs nonproducing ones.CONCLUSIONS Bacterial resistance is still or even a more serious clinical problem than before.The(surveillance) of antimicrobial susceptibility in pediatric hospital is of great significance.It is also very important to promote the rational use of antimicrobial agents so that resistance is minimized and take effective strategy for the control of the problem.