儿科住院患者病原菌分布及耐药性分析

目的：分析2012年我院儿科住院患者病原菌分布及耐药性.方法：采用纸片扩散法（K-B法）进行抗菌药物敏感性试验,E试验检测肺炎链球菌对青霉素和头孢曲松及葡萄球菌对万古霉素的最低抑菌浓度（MIC）.结果：2012年我院儿科患者共分离临床非重复菌1037株,其中革兰阳性菌423株（40.8％）,革兰阴性菌614株（59.2％）.前10位病原菌分别为克雷伯菌属（14.3％）、肺炎链球菌（14.2％）、金黄色葡萄球菌（12.7％）、大肠埃希菌（12.0％）、流感嗜血杆菌（10.1％）、凝固酶阴性葡萄球菌（8.2％）、不动杆菌属（7.0％）、铜绿假单胞菌（4.3％）、肠杆菌属（4.2％）、卡他莫拉菌（3.8％）.耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林的凝固酶阴性葡萄球菌（MRSCN）的检出率分别为15.9％和91.8％,青霉素不敏感肺炎链球菌（PNSP）检出率为17.0％,检出1株万古霉素耐药粪肠球菌.大肠埃希菌和克雷伯菌属中超广谱β内酰胺酶（ESBL）检出率分别为77.2％和52.7％.铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为13.3％和9.5％,不动杆菌属对亚胺培南和美罗培南的耐药率分别为15.1％和14.1％.流感嗜血杆菌和卡他莫拉菌β内酰胺酶阳性率分别为43.3％和100％.结论：临床常见病原菌仍以革兰阴性杆菌为主,与2010年全国儿童细菌耐药监测数据相比,耐碳青霉烯类肠杆菌科细菌上升趋势明显,应引起临床和医院感染控制部门的重视.

Analysis of the antimicrobial resistance and the profile of pathogens isolated from pediatiric inpatients

Objective ： To analyze the antimicrobial resistance and the profile of pathogens isolated from pediatric inpatients in 2012. Methods： Antimicrobial susceptibility was tested by Kirby-Bauer method. The minimum inhibitory concentration （MIC） of penicillin and ceftriaxone for Streptococcus pneumoniae and vaucomycin for Staphylococcus spp. were determined by E-test. Results： A total of 1,037 strains were isolated from pediatric patients in 2012, including gram-positive bacteria （423, 40. 8% ） and gram-negative bacteria （614, 59. 2% ） . The top ten pathogens were Klebsiella spp. （ 14.3% ）, Streptococcus pneumoniae （ 14.2% ）, Staphylococcus aureus （ 12.7% ） , Escheria coli （ 12.0% ）, Haemophilus influenzae （ 10. 1% ）, Coagulase-negative Staphylococcus （ 8.2% ）, Acinetobacter spp. （ 7.0% ） , Pseudomonas aeruginosa （4.3%）, Enterobacter spp. （4.2%） and Moraxelle catarrhalis （3.8%）. The prevalence of methicillin-resistant Staphylococcus aureus （MRSA） and methicillin resistant coagulase negative staphylococci （MRCNS） was 15.9% and 91.8% respectively. The prevalence of penicillin-non-susceptible S. pneumoniae （PNSP） was 17.0%. One strain of vancomycin resistant Enterococcus faecalis was detected. The prevalence of extended-spectrum beta-lactamase （ESBL） in E. coli and Klebsiella spp. were 77.2% and 52.7% respectively; that of imipenemand memropenem resistant P. aerugonosa and Acinetobacter spp. was 13.3% and 9.5% ; 15.1% and 14.1% respectively; that of beta-lactamase in H. influenzae and M. catarrhalis was 43.3% and 100%, respectively. Conclusions： Most isolates from our hospital in 2012 were gramnegative bacteria. The prevalence of carbapenem-resistant Enterobacteriaceae obviously increased as compared with the reported data in 2010.