2015-2017年重庆地区儿童和成人血培养分离革兰阴性菌分布及耐药性分析  

Different antibiotic resistance profile of clinical gram negative isolates from blood culture between adults and pediatric patients in Chongqing,2015-2017

作　　者：徐浩峰 田田 杨双双[1] 孙珊[1] 孙继德[1] XU Haofeng;TIAN Tian;YANG Shuangshuang;SUN Shan;SUN Jide(Department of Laboratory Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院检验科,重庆400016

出　　处：《中国感染与化疗杂志》2019年第1期64-70,共7页Chinese Journal of Infection and Chemotherapy

基　　金：重庆市科学技术委员会基础与前沿一般项目(cstc2016jcyjA0248)

摘　　要：目的分析重庆地区血培养分离病原菌的分布和耐药性及患者年龄差异。方法回顾性分析2015-2017年重庆地区耐药监测网中血标本分离革兰阴性菌患者年龄分布特征,采用仪器配套药敏卡检测,药敏结果数据使用WHONET5.6和GraphpadPrism6进行分析。结果 3年血培养阳性非重复株20145株。检出排名前3位的革兰阴性菌是大肠埃希菌(56.7%,6688/11799)、肺炎克雷伯菌(19.6%,2308/11799)和铜绿假单胞菌(4.4%,522/11799)。大肠埃希菌对碳青霉烯类耐药率<1%,而肺炎克雷伯菌在5%左右,阴沟肠杆菌和黏质沙雷菌为9%左右。成人中大肠埃希菌对半数受试抗菌药物耐药率显著高于儿童,肺炎克雷伯菌则相反。鲍曼不动杆菌总体耐药率高于铜绿假单胞菌,成人中鲍曼不动杆菌对所测抗菌药物耐药率均显著高于儿童。结论重庆地区血培养阳性的革兰阴性菌中以大肠埃希菌和肺炎克雷伯菌为主。细菌对碳青霉烯类药物仍保持较高的敏感性。但儿童患者中分离的碳青霉烯类耐药肺炎克雷伯菌和成人患者中分离的碳青霉烯类耐药鲍曼不动杆菌应引起临床高度重视。Objective To analyze the age difference of gram negative isolates(GNB) from blood culture and antibiotic resistance profile between children and adults. Methods Age difference of pathogen distribution of GNB isolated from blood culture during 2015-2017 were retrospectively analyzed. WHONET 5.6 and Graphpad Prism 6 were used to perform Chi-square test on the pathogen proportion and antibiotic resistance rate. Results A total of 20 145 bacterial strains were isolated in Chongqing from 2015 to 2017. The top three strains of GNB were E. coli(56.7%, 6 688/11 799), K. pneumoniae(19.6%, 2 308/11 799), and P. aeruginosa(4.4%, 522/11 799). The resistant rate of E. coli to carbapenems was less than 1%. The resistant rate of K. pneumoniae to carbapenems was about 5%, while the resistant rate of S. marcescens was approximately 9%, similar to E. cloacae. The overall resistance rates of E. coli from adult patients to most antiobiotic agents were significantly higher than those of children, but the overall resistance rate of K. pneumoniae from children was higher than those of adults. The drug resistance rate of A. baumannii was higher than P. aeruginosa. A. baumannii isolates from adult patients were highly resistant to all drugs tested and more resistant than those from pediatric patients. Conclusions Majority of GNB strains isolated from blood culture were E. coli and K. pneumoniae, for which carbapenems are still active. More attention should be paid to carbapenem-resistant K. pneumoniae from children and A. baumannii from adults. National surveillance of nosocomial bloodstream infection should be highly evaluated.

关 键 词：血培养 革兰阴性菌 耐药性 成人 儿童 

分 类 号：R378[医药卫生—病原生物学]