重症感染患儿细菌学调查及耐药性分析

目的：了解本院儿科重症感染患儿的细菌种类、分布及耐药情况，指导临床合理用药。方法：对本院2005年2月-2007年8月间儿科病区收住的53例重症感染患儿感染菌株种类、分布、耐药情况进行统计分析。结果：本组患儿检出感染菌中革兰阳性菌、革兰阴性菌的检出率分别为52．83％（28／53）和43．30％（23／53），差异无统计学意义（P〉0．05）；而血培养结果显示菌毒血症患儿仍以革兰阴性菌为主（P〈0．05）。检出的革兰阳性菌中88．24％对青霉素耐药，但对万古霉素均敏感；革兰阴性菌对碳青霉烯类抗生素敏感，但对常用的抗生素包括复合制剂和第四代头孢菌素也有一定的耐药性。结论：菌毒血症患儿以革兰阴性菌感染为主，碳青霉烯类抗生素为治疗首选药。革兰阳性菌感染的患儿则以万古霉素为治疗首选药。出现一些新的条件致病菌感染感染细菌呈现对新合成抗生素的耐药性，应注意抗生素的规范使用，加强对细菌耐药性监测。

Spectrum of Bacteria and Antibiotic Resistance among Children with Severe Infections

Objective： To investigate the clinical profiles including bacterial spectrum, distribution and antibiotie resistance among children with severe infection in our hospital, and to provide advices for rational use of antibiotics. Methods： Fifty-three children with severe infeetions in our hospital from Feb 2005 to Aug 2007 were enrolled in the study. The clinical profiles including bacterial spectrum, distribution and antibiotic resistance were analyzed retrospectively. Results：Grampositive and negative bacteria were found in 52.83% （28 of 53） and 43.30% （23 of 53）, respectively, of all children, with no statistical difference in prevalence （P〉0.05）. By blood culture, Gram-negative strains remained the most prevalent microbes in children with sepsis （P〈0.05）. Of all Gram-positive bacteria, 88.24% were resistant to Penicillin, but all showed susceptibility to Vancomycin. The Gram-negative strains were susceptible to Carbapenems but appeared resistant to common antibiotics including compound agents and fourth generation Cephalosporins. Conclusion：The Gram-negative bacteria were found to be the most prevalent strains in children with sepsis, for which Carbapenems remains first-line therapy. In those infected with Gram-positive bacteria, Vancomycin should be the first choice. Given the resistance to new compound antibiotics in some of conditional pathogenic strains, high alerts should be prompted to rational use of clinical antibiotics according to drugsensitivity test.