PICU多药耐药菌分布与耐药性分析  

Distribution and drug resistance of multidrug-resistant bacteria in PICU

作　　者：张海金[1] 李荣[1] 程丽萍[1] 姜亚绒[1] 沈红莉[1] 任红月[1] 黄宏志[1] 陈晴[1] 

机构地区：[1]西安市儿童医院控感办,陕西西安710003

出　　处：《中华医院感染学杂志》2015年第5期995-997,共3页Chinese Journal of Nosocomiology

基　　金：陕西省卫生厅科研基金资助项目(2010H9)

摘　　要：目的了解儿科重症监护病房(PICU)多药耐药菌分布及其耐药性,为临床用药提供合理的参考依据。方法对2012年6月-2013年5月儿童医院PICU分离的112株多药耐药菌分布、构成及耐药性进行回顾性分析。结果 PICU共分离112株多药耐药菌,以革兰阴性菌为主,85株占75.9%,其中比例最高为鲍氏不动杆菌,48株占42.9%,其次为大肠埃希菌和肺炎克雷伯菌,分别占13.4%和12.5%;革兰阳性菌27株占24.1%;鲍氏不动杆菌对亚胺培南的耐药率为95.8%,大肠埃希菌和肺炎克雷伯菌对头孢噻肟的耐药率达100.0%;金黄色葡萄球菌对青霉素和阿奇霉素的耐药率高达100.0%;PICU患儿感染的主要革兰阳性多药耐药菌对万古霉素和替考拉宁敏感,主要革兰阴性菌对环丙沙星、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦敏感。结论 PICU患儿多药耐药菌感染主要以革兰阴性菌为主,临床应根据细菌培养、药物敏感试验结果调整用药,合理选用抗菌药物,减少耐药菌株的产生,控制多药耐药菌的感染流行。OBJECTIVE To investigate the distribution and drug resistance of multidrug‐resistant bacteria isolated from pediatric intensive care unit （PICU ） so as to provide guidance for reasonable clinical use of antibiotics . METHODS A total of 112 strains of multidrug‐resistant bacteria were isolated from the PICU of the children＇s hos‐pital from Jun 2012 to May 2013 ,then the distribution ,constituent ratios ,and drug resistance of the strains were retrospectively analyzed .RESULTS Totally 112 strains of multidrug‐resistant bacteria have been isolated ,including 85 （75 .9% ） strains of gram‐negative bacteria and 27 （24 .1% ） strains of gram‐positive bacteria ;the Acinetobacter baumannii （48 strains ,42 .9% ） was the predominant species of gram‐negative bacteria ,followed by the Esche‐richia coli （13 .4% ） and K lebsiella pneumoniae （12 .5% ） .The drug resistance rate of the A .baumannii to imi‐penem was 95 .8% ,the drug resistance rate of the E .coli and K .pneumoniae to cefotaxime was 100 .0% ,and the drug resistance rates of the Staphylococcus aureus to penicillin and azithromycin were as high as 100 .0% .The major species of multidrug‐resistant gram‐positive bacteria were susceptible to vancomycin and teicoplanin ,and the main gram‐negative bacteria were susceptible to ciprofloxacin ,cefoperazone‐sulbactam ,and piperacillin‐tazobac‐tam .CONCLUSION The gram‐negative bacteria are dominant among the multidrug‐resistant bacteria causing infec‐tions in the children of PICU .It is necessary for the hospital to adjust the drug therapy according to the results of bacterial culture and drug susceptibility testing and reasonably use antibiotics so as to reduce the drug‐resistant strains and control the prevalence of multidrug‐resistant bacteria infections .

关 键 词：多药耐药菌 儿科重症监护病房 耐药性 

分 类 号：R378[医药卫生—病原生物学]