儿科重症监护室细菌感染流行菌及其耐药性

目的研究我院儿科重症监护室(PICU)临床病原菌的变迁及其对常用抗生素的耐药性,指导临床合理选用抗生素。方法统计分析自1999年来对PICU临床分离细菌的监测,对2153例患儿采集标本1684例次,标本主要来源于呼吸道、脓液、尿、便和各种体液等。结果467例患儿细菌分离阳性,共分离病原体526株,其中革兰阳性菌100株(19·0%),主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌和肺炎链球菌等;革兰阴性菌355株(67·5%),主要为克雷伯菌属、大肠埃希菌、铜绿假单胞菌、肠杆菌、阴沟杆菌、嗜麦芽窄食单胞菌、黄杆菌等;真菌71株(13·5%)。近年来凝固酶阴性葡萄球菌有增多趋势。细菌耐药性检测结果提示PICU中革兰阴性菌对头孢唑啉敏感率17·9%,对头孢哌酮、头孢三嗪敏感率约50%,头孢他啶敏感率65·4%,头孢吡肟敏感率81·3%。葡萄球菌是阳性菌中主要耐药菌株,其耐甲氧西林发生率>55%,氨基糖苷类和万古霉素敏感率高;革兰阴性菌中主要耐药菌是克雷伯菌、大肠埃希菌和阴沟杆菌中产超β-内酰胺酶菌,其发生率分别是29·8%、22·2%和21·9%,对喹诺酮类和碳青霉烯类抗生素敏感。结论加强耐药性监测,合理使用抗生素十分重要。

Bacterial infection in PICU: epidemiology and drug resistance

Objective To study the change in pathogenic bacterium spectrum and drug resistance in PICU to promote rational antibiotic use.Methods From 2153 PICU patients,1684 specimens from respiratory tract,pus,urine,stool or body fluid were collected ever since 1999.The drug resistance of bacterium isolated from PICU patients was analyzed.Results 467 patients were positive in bacterial isolation and 526 strains were identified.The percentages of Gram-positive,Gram-negative bacterium and fungus were 19.0%,67.5%,and 13.5% respectively.In the recent years,coagulase negative staphyloccus infection increased.Bac- terial resistance survey in PICU indicated that the susceptibility rate of Gram-negative bacterium against cefazolin,cefoperazone(or ceftriaxone),ceftazidime and cefotaxime were 17.9%,50%,65.4% and 81.3%.Staphylococcus was the major drug-resistant bacteria among the Gram-positive bacterium.Meticilin resistant staphylococcus accounted for more than 55% and they were more sensitive to aminoglycoside antibiotic and vancomycin.Klebsiella,Escherichia coli and ESBL-producing stains of Escherichia coli were the major drug-resistant bacteria among Gram-negative bacterium,which accounted for 29.8%,22.2% and 21.9%.Quinolones and carbapenems were the effective antibiotics.Conclusion It is important to select antibiotics rationally for the treatment of infection in PICU according to the results of susceptibility tests.