2017-2018年南京市儿童医院儿科重症监护病房感染病原菌的分布及耐药性分析

目的 了解南京市儿童医院儿科重症监护病房（PICU）病原菌的分布及耐药性，为临床合理选用抗菌药物提供依据。方法 对2017年1月-2018年12月南京市儿童医院PICU住院患儿送检标本所分离的病原菌及其耐药性进行回顾性分析。结果 共分离出306株病原菌，主要来自痰液，共191例，构成比为62.41%。革兰阳性菌120株，构成比为39.21%，主要为金黄色葡萄球菌、肺炎链球菌和屎肠球菌；革兰阴性菌166株，构成比为54.25%，主要为肺炎克雷伯菌、流感嗜血杆菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌；真菌20株，构成比为6.54%。金黄色葡萄球菌对环丙沙星、替加环素、万古霉素、左氧氟沙星、喹努普汀/达福普汀、利福平、利奈唑胺、莫西沙星和庆大霉素完全敏感；金黄色葡萄球菌对青霉素G的耐药率高达93.88%。肺炎链球菌对克林霉素、红霉素完全耐药，耐药率为100.00%，未发现对氯霉素、青霉素G、万古霉素的耐药菌株。屎肠球菌对氨苄西林和青霉素G完全耐药，耐药率为100.00%，未发现对喹努普汀/达福普汀、利奈唑胺、替加环素和万古霉素的耐药菌株。肺炎克雷伯菌对氨苄西林完全耐药，耐药率为100.00%，未发现对左氧氟沙星、环丙沙星的耐药菌株；流感嗜血杆菌对头孢曲松和美洛培南的耐药率较低，均为3.70%。大肠埃希菌对阿米卡星完全敏感。铜绿假单胞菌对左氧氟沙星、环丙沙星、妥布霉素、庆大霉素、阿米卡星完全敏感。鲍曼不动杆菌除了对头孢噻肟完全耐药外，对其他抗菌药物的耐药率均较低，且对左氧氟沙星完全敏感。结论 南京市儿童医院PICU医院感染菌耐药性严重，应加强病原菌耐药性的监测，为临床合理应用抗菌药物提供依据。

Analysis on distribution and drug resistance of pathogenic bacteria causing nosocomial infections in PICU of Nanjing Children's Hospital from 2017 to 2018

Objective To investigate the distribution and drug resistance of pathogens causing nosocomial infections in children of pediatric intensive care unit (PICU) from Nanjing Children''s Hospital, so as to provide laboratory basis for clinical trentment of infections. Methods The distribution and drug resistance of pathogens causing nosocomial infections in PICU of Nanjing Children''s Hospital from January 2017 to December 2018 were retrospectivly analyzed. Results A total of 306 strains of pathogenic bacteria were isolated, of which 191 strains were obtained from sputum, accounting for 62.41%. There were 120 stains of Gram-positive bacteria with a composition ratio of 39.21%, mainly including Staphylococcus aureus, Streptococcus pneumonia, and Enterococcus faecium. Gram-negative bacteria were 166 strains, accounting for 54.25%, mainly including Klebsiella pneumonia, Haemophilus influenza, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii. Fungi were 20 strains, accounting for 6.54%. S. aureus was completely sensitive to iprofloxacin, tetoxycline, vancomycin, levofloxacin, quinupristin/dalfopristin, rifampicin, linezolid, moxifloxacin, and gentamicin. The drug resistance rate of S. aureus against penicillin G was high to 93.88%. S. pneumonia was completely sensitive to clindamycin and erythromycin with the drug resistance rate of 100.00%. There was no S. pneumonia resistant to chloramphenicol, penicillin G, and vancomycin. E. faecium was completely sensitive to ampicillin and penicillin G with the drug resistance rate of 100.00%. There was no E. faecium resistant to quinupristin/dalfopristin, linezolid, tegacycline, and vancomycin. K. pneumonia was completely sensitive to ampicillin with the drug resistance rate of 100.00%. There was no K. pneumonia resistant to levofloxacin and ciprofloxacin. The drug resistance rate of H. influenzae against ceftriaxone and meropenem was lower with 3.70%. E. coli was completely sensitive to amikacin. P. aeruginosa was completely sensitive to levofloxacin, ciprofloxacin, tobramycin, gentamicin, and amikacin. Except for complete resistance to cefotaxime, A. baumannii had low resistance rate to other antibacterial drugs and was completely sensitive to levofloxacin. Conclusion The nosocomial infections in the PICU and drug resistance are serious. Monitoring of drug resistance of pathogenic bacteria should be strengthened to provide basis for clinicians to reasonably apply antibacterial drugs.