105例社区获得性儿童败血症病原学及体外耐药分析  

Pathogens and Their Antimicrobial Resistance in 105 Children with Community-acquired Bacteremia

作　　者：单小鸥[1] 李昌崇[1] 

机构地区：[1]温州医学院附属二院育英儿童医院儿童急诊科,浙江温州325003

出　　处：《中华医院感染学杂志》2008年第5期737-739,共3页Chinese Journal of Nosocomiology

基　　金：浙江省回国人员科研启动费(2005-097)

摘　　要：目的探讨105例社区获得性儿童败血症的病原学分布及耐药情况,以指导儿科急诊合理、经验用药。方法对2003年1月-2006年12月105例经临床与血培养证实的社区获得性儿童败血症的临床资料进行回顾性分析。结果革兰阳性菌58例,占55.2%,其中以表皮葡萄球菌、溶血葡萄球菌、人葡萄球菌为主,分别占革兰阳性菌的19.0%、15.5%、10.3%;革兰阴性菌47例,占44.8%,其中以大肠埃希菌、嗜麦芽寡养单胞菌、肺炎克雷伯菌为主,分别占革兰阴性菌的19.1%、14.9%、10.6%;81.9%的病原菌分布<3周岁,66.1%的病原菌分布<1周岁;葡萄球菌属对青霉素G的耐药率达100.0%,对红霉素的耐药率达94.7%;革兰阳性菌对万古霉素100.0%敏感,绝大多数对环丙沙星、利福平和呋喃妥因敏感;革兰阴性菌对氨苄西林的耐药性达91.7%,大多数对头孢三代加酶抑制剂、环丙沙星、亚胺培南敏感;分离的病原菌对许多儿科常用的抗菌药物产生耐药性。结论<3周岁发热患儿是败血症监测的重点;经验性使用抗菌药物仅推荐儿科急诊致命性感染患儿。OBJECTIVE To determine the pathogenic distribution and antimicrobial resistance of community acquired bacteremia in 105 children patients. METHODS Clinical profile, results of blood culture and antibiotic susceptibility test of 105 patients with community-acquired bacteremia treated from Jan 2003 to Dec 2006 were studied retrospectively. RESULTS The Gram-positive bacteria were from 58 cases which accounted for 55.2%. Most of them were Staphylococcus epidermidis, S. haemolyticus and S. hominis. The positive rate was 19.0%, 15.5% and 10. 3%, respectively. The Gram-negative bacilli were seen from 47 cases which accounted for 44.8%. Escherichia coli ,Stenotrophomonas maltophilia and Klebsiella pneumoniae were the main microrganism in Gram- negative bacilli, the positive rate was 19. 1%, 14. 9% and 10. 6%, respectively. The resistant rate of Staphylococcus to penicillin was 100%. Their resistant rate to erythromycin was 94.7%. 100% Gram-positive bacteria were susceptible to vancomycin, most of them were susceptible to ciprofloxacin, rifampicin and nitrofurantoin. The resistant rate of Gram-negative bacilli to ampicillin was 91.7%. Most of Gram-negative bacilli were susceptible to the third generation cephlosporin plus enzyme inhibitor, ciprofloxacin and imipenem. Resistance of the isolated pathogens to several commonly used antibiotics in pediatrics was observed. CONCLUSIONS We must focus on children aged under 3 years who are at risk Of developing bacteremia. Empirical treatment with antibiotics is recommended only in life-threatening sepsis cases in pediatric emergency department.

关 键 词：败血症 病原菌 耐药 儿童 

分 类 号：R378[医药卫生—病原生物学]