PICU分离细菌耐药性分析

目的调查我院PICU临床感染病原菌的分布及耐药情况，指导临床合理用药。方法回顾性分析2010年1月至2011年12月我院PICU分离出的病原菌及耐药性。结果有349例患儿共分离出471株病原菌，标本来源为痰、血、导管、尿及脑脊液等，其中分离革兰阴性杆菌285株（60．5％），革兰阳性球菌168株（35．7％），真菌18株（3．8％）。主要病原菌为：鲍曼不动杆菌88株（18．7％）、肺炎克雷白杆菌70株（14．9％）、铜绿假单胞菌51株（10．8％）、肺炎链球菌45株（9．6％）以及大肠埃希菌43株（9．1％）。超广谱β内酰胺酶阳性肺炎克雷白杆菌和大肠杆菌的比例分别为65．7％（46／70）及37．2％（16／43），对绝大多数头孢类抗生素耐药率〉85．0％，非发酵菌的多重耐药情况严重，鲍曼不动杆菌对绝大多数头孢类抗生素耐药率〉70．0％，其中多重耐药菌株78株（88．7％），泛耐药株58株（66．0％）。耐甲氧西林金黄色葡萄球菌（7株）及耐甲氧西林凝固酶阴性葡萄球菌（16株）分别占金黄色葡萄球菌及凝固酶阴性葡萄球菌的31．8％和53．3％，对万古霉素全部敏感。结论PICU中病原菌以革兰阴性杆菌为主，耐药情况较严重，因此加强病原菌分布及耐药性监测十分重要，以指导临床抗感染治疗，防止滥用抗生素。

Analysis of epidemic distribution and drug resistance of pathogens in PICU

Objective To investigate the epidemic distribution and drug resistance of pathogens in PICU in Shengjing Hospital of China Medical University. Methods We retrospectively analyzed the patho- gens isolated from patients in PICU from Jan 2010 to Dec 2011. The specimens were from sputum, bloodstream,tube （such as endotracheal tube, deep vein catheterization）, urine, cerebrospinal fluid and so on. Results Total of 471 pathogens were isolated from 349 patients, and Gram-negative bacilli, Gram-positive cocci and fungi accounted for 60. 5% （285/471） ,35.7% （ 168/471 ） ,3.8% （ 18/471 ） respectively. The top 5 pathogens were the followings： Acinetobacter baumannii 88 strains （ 18.7 % ）, Klebsiella pneumonia 70 strains （ 14. 9% ） ,Pseudomonas aeruginosa 51 strains （ 10. 8% ）, Stroptococci pneumonia 45 strains （9. 6% ） and Escherichia coli 43 strains （9. 1% ） ;the rate of extended-spectrum beta-lactamase-producing strains of Klebsiella pneumonia and Escherichia coli were 65.7% （46/70）and 37.2% （ 16/43 ） respectively, and the resistant rates of them to Cephalosporin antibiotics were more than 85.0%. There was severe condition of multidrug resistance for non-fermentation bacteria, especially for Acinetobacter baumannii. The resistant rate of Acinetobacter baumannii to most Cephalosporin antibiotics was more than 70%, including 78 multidrug-resistant strain （88.7 % ） and 58 pandrug-resistant strain （66. 0% ）. In Gram-positive cocci, 31.8 % of staphylococcus aureus and 53.3% of coagulase negative staphylococci were Methicillin resistant staphylococcus aureus （7 strains） and Methicillin resistant coagulase negative staphylococci （16 strains） ,which were 100% sensitive to Vancomycin. Conclusion Gram-negative bacilli are the main pathogens in PICU, and drug resistance rate is high. Recently the multi-drug resistance is increasing. So it is important to carry out surveillance of pathogens distribution and bacterial resistance.