2003—2008年儿科临床分离菌的分布变迁及耐药性监测  

The changing pattern and antibiotic resistance of clinical bacterial isolates in a pediatric clinic from 2003 to 2008

作　　者：董方[1] 徐樨巍[1] 宋文琪[1] 吕萍[1] 冯东霞[1] 刘锡青[1] 曾俊红[1] 

机构地区：[1]首都医科大学附属北京儿童医院细菌室,北京100045

出　　处：《中国感染与化疗杂志》2009年第6期440-445,共6页Chinese Journal of Infection and Chemotherapy

基　　金：国家科技部十五攻关项目(2004BA720A09-01)

摘　　要：目的了解目前儿科临床分离细菌种类分布及对抗菌药物的耐药性变化。方法对2003—2008年北京儿童医院住院患儿所有临床分离菌株进行分析,药敏试验使用纸片扩散法和Phoenix100微生物分析仪检测,按CLSI2008年标准进行。使用WHONET5.4软件进行数据的统计分析。结果临床分离革兰阴性菌比率呈上升趋势,革兰阴性菌以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌为主。革兰阳性菌以金葡菌、肺炎链球菌和凝固酶阴性葡萄球菌为主。肺炎链球菌是儿科呼吸系统、中枢神经系统和血流感染的重要病原菌,在呼吸道标本中其分离率最高,肺炎链球菌对青霉素不敏感率82.5%。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)占CNS79.8%～92.7%;MRSA升至10.6%。肺炎链球菌、葡萄球菌和肠球菌均未发现耐万古霉素的耐药株,但有万古霉素中介的肠球菌检出。革兰阴性菌中,产ESBLs大肠埃希菌菌株占73.9%～80.0%;肺炎克雷伯菌为70.5%～81.5%。不发酵糖菌的铜绿假单胞菌对碳青霉烯类抗生素(亚胺培南、美罗培南)耐药率分别为11.3%和9.2%,鲍曼不动杆菌对两者的耐药率均为3.3%。结论儿科临床分离CNS、肺炎链球菌、肠球菌属、大肠埃希菌和克雷伯菌属的耐药处于较高水平,加强儿科临床分离细菌的监测,对于了解儿科临床分离细菌分布及其耐药性变迁,指导临床合理用药防止耐药菌产生和播散都有重要意义。Objective To investigate the changing pattern of common bacterial pathogens and their resistance in the pediatric clinic in Beijing Children＇s Hospital. Methods All the bacterial isolates isolated in our hospital from 2003 to 2008 were ana- lyzed. Antimicrobial susceptibility was determined by disk diffusion method and Phoenix 100 microbiological system. Results were analyzed according to the guidelines of CLSI. Results Gram-negative bacteria became important pathogens of nosocomial infections. E. coli, P. aeruginosa and K. pneumoniae were the leading gram-negative pathogens. S. aureus, S. pneurnoniae and coagulase-negative Staphylococcus （CNS） were common gram-positive pathogens. About 82.5 % of the S. pneumoniae isolates were penicillin non-susceptible （PNSP）. The prevalence of methicillin-resistant CNS （MRCNS） ranged from 79.8% to 92.7%. Up to 10.6% of the S. aureus isolates were methicillin-resistant （MRSA）. No isolate of S. pneumoniae, S. aureus or Enterococcus was found resistant to vancomycin. The prevalence of extended-spectrum β-lactamase （ESBLs） producing strains ranged from 73.9% to 80.0% in E. coli and 70.5% to 81.5% in K. pneumoniae. The resistance rate of P. aeruginosa to imipenem and meropenem was 34. 2% and 35.8%, respectively. About 3.3% of the A. baumannii isolates were resistant to carbapenems. Conclusions The clinical strains of CNS, S. pneumoniae, Enterococcus, E. coli and K. pneurnoniae isolated from the pediatric clinic have shown high resistance to multiple antibiotics. The surveillance of antimicrobial resistance is very important for rational antimicrobial therapy and effective control of infections in pediatric clinic.

关 键 词：微生物 抗菌药物 细菌耐药性监测 

分 类 号：R446.5[医药卫生—诊断学]