儿童血源性感染患者病原菌菌群分布及耐药性分析

目的了解2012年住院患儿血培养中分离的病原菌分布及耐药状况,为血源性感染患儿的临床诊治与流行病学特征提供用药依据。方法回顾性分析该院导致血源性感染的663株病原菌分布及其抗菌药物耐药情况。结果 6 333份血培养标本分离出病原菌663株,阳性率10.5%;其中革兰阳性球菌404株占60.9%,包括凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌属;革兰阴性杆菌253株占38.2%,主要包括阴沟肠杆菌、铜绿假单胞菌、木糖氧化产碱杆菌、嗜麦芽窄食假单胞菌等;真菌6株占0.9%。药敏试验检出革兰阳性球菌对万古霉素、利奈唑胺敏感,对青霉素、红霉素、氨苄西林〉90%以上耐药;革兰阴性杆菌未发现耐亚胺培南菌株。结论儿童血液感染患者菌种较复杂,革兰阳性球菌是引起菌血症的主要病原菌,药敏结果提示检出菌株耐药性较强,因此需要根据血液感染细菌的分布特性和耐药性,选择敏感的抗生素治疗血源性感染患儿。

Distribution and drug-resistance of pathogens caused by bloodstream infections in children patients

Objective To analyze the distribution and resistance of pathogens in blood culture species,so as to examine the clinical and epidemiological features of nosocomial bloodstream infectious（BSIS）-caused Gram-positive pathogens species,which were found in Anhui Provincial Children＇s Hospital from 1 Jan 2012 through 31 Dec 2012. Methods Distribution and resistance of 663 isolates were restropectively studied. Results Six hundred and sixty-three strains of pathogenic bacteria were separated from the specimens of 6333blood culture samples in our hospital. The positive rate was 10. 5%. Of these strains 404（60. 9%） were Gram-positive bacteria,including CONS,Staphylocosaureus,Enterococci,253（38. 2%） were Gram-negtive bacteria,including E. cloacae,P. aeruginosa,A. xylosoxidans,S. maltophilia,and 6（0. 9%） were fungus. Gram-positive bacillis was sensitive to Vancomyc and Linezolid. Compared with children patients with nosocomial bloodstream infection caused by other Gram-negative pathogens,90% resistant to ≥3 classes of amtimicrobials and were considered to be multidrug resistant including anti-imipenem isolates. Conclusions The resurgence of gram-positive bacteria is the predominant cause of nosocomical infectious pathogens in children patients in our hospital. Many Gram-positive cocci are now resistant to commonly used antibiotics. Therefore,newer,more effective antimicrobial therapies are needed to treat bloodstream infections according to the distribution and resistant of BSIS.