儿童医院临床分离多重耐药菌的流行病学分析

目的 分析某儿童医院临床分离多重耐药菌的分布情况及耐药特点,为医院多重耐药菌的预防和治疗提供临床依据.方法 采用回顾性分析方法,收集2018年1月至2020年12月某儿童医院住院患者送检标本临床分离病原菌中排名前5位的多重耐药菌检出结果等资料,了解检出多重耐药菌的患儿年龄、性别、科室分布情况并进行耐药性分析.结果3 a...

Epidemiological Analysis of Clinical Isolation of Multi-drug Resistant Bacteria in Children's Hospitals

  Objective   To analyze the distribution and characteristics of multi-drug-resistant bacteria isolated from the clinic in a children’ s hospital, providing the clinical evidence for the prevention and treatment of multi-drug-resistant bacteria in the hospital.   Methods   A retrospective analysis method was used to collect the data of the top five multi-drug-resistant bacteria of clinically isolated pathogens from inpatients in a children’ s hospital from January 2018 to December 2020, to understand the age, sex, and department distribution in children of multi-drug resistance bacteria, and analyze the drug resistance.   Results   1451 strains of multi-drug resistant bacteria were clinically isolated in three years, and the top five were ESBLs-producing Escherichia coli, MRSA, ESBLs-producing Klebsiella pneumoniae, CRAB, and CRKP. The detection rates of ESBLs-producing Escherichia coli, MRSA, and ESBLs-producing Klebsiella pneumoniae were not statistically different in each year （P = 0.163, P = 0.125, P = 0.174）, and the detection rate of CRAB first increased and then decreased （ P < 0.001）, the detection rate of CRKP was decreasing year by year （P = 0.001）. The majority of children with multi-drug-resistant bacteria were boys （55.4%） and infants （43.6%）. The department with the highest detection rate was neurosurgery, with 9.18%, followed by burn plastic surgery, with a detection rate of 4.32%; specimen types had the highest positive rate of secretion, which was 7.06%. The main type of specimens was sputum （52.3%）. The drug sensitivity results showed that the resistance rates of ESBLs-producing Escherichia coli to penicillins, cefazolin and ceftriaxone were greater than 99%. The resistance rate of MRSA to penicillins was 100%, and the resistance rates to vancomycin, linezolid, tigecycline were all 0.0%. The resistance rates of ESBLs-producing Klebsiella pneumoniae to penicillins, cefazolin and ceftriaxone were 100.0%. In 2018, the resistance rate of Acinetobacter baumannii to meropenem was 16.7%, and the resistance rates to the other 13 antibacterial drugs were all 100.0%. In 2019 and 2020, The resistance rates of Acinetobacter baumannii to nitrofurantoin, cefazolin, ampicillin were 100.0%, and the resistance rates to other antibiotics were lower than those in 2018. The resistance rates of CRKP to penicillins, cephalosporins and carbapenem antibiotics were above 90.0%.  Conclusion   In recent years, the situation of multi-drug resistant bacteria in children’ s hospitals has been severe. The management of the rational use of clinical antimicrobials should be strengthened to reduce the occurrence of drug-resistant bacteria.