PICU细菌病原学谱五年变迁及耐药性分析  

Five years change of bacterial spectrum and drug resistance in PICU

作　　者：张莉[1] 周涛[1] 罗序峰[1] 陈昂[1] 任伟[1] 付四毛[1] 刘玉玲[1] 

机构地区：[1]南方医科大学附属中山市博爱医院儿科,528400

出　　处：《中国小儿急救医学》2015年第5期320-323,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的分析近5年我院PICU细菌病原学谱的特点及其耐药性改变，指导临床合理用药。方法回顾性分析2009年1月1日至2013年12月30日我院PICU所有细菌培养阳性结果，按不同年份进行分类，了解各年份PICU细菌病原学谱及耐药性，总结其变化特点。结果5年中，我院PICU共送检标本14361份，分离出2201株病原菌，培养阳性率15．3％。其中革兰阴性菌63．9％（1406株），革兰阳性菌36．1％（795株）。2009至2013年革兰阴性菌所占比例分别为83．2％、71．O％、59．8％、58．9％、52．5％；革兰阳性菌所占比例分别为16．8％、29．0％、40．2％、41．1％、47．5％。前五位病原菌为：金黄色葡萄球菌（16．6％，366株）、大肠埃希菌（16．2％，357株）、肺炎克雷白杆菌（15．2％，334株）、肺炎链球菌（9．2％，202株）、流感嗜血杆菌（6．8％，149株）。其中，金黄色葡萄球菌感染率逐年上升（6．4％-27．0％）。药敏结果显示超广谱B内酰胺酶阳性大肠埃希菌及肺炎克雷白杆菌比例分别为28．3％、38．3％；耐甲氧西林金黄色葡萄球菌比例为26．0％；肺炎链球菌按照非颅内感染折点判断，对青霉素耐药率为19．3％，多重耐药比例为58．9％。上述各菌株5年内耐药率无明显变化。结论近5年PICU细菌病原学谱仍以革兰阴性菌为主，但革兰阳性菌感染比例逐年升高，金黄色葡萄球菌已成为近5年我院PICU最常见致病菌之一。5年中，超广谱8内酰胺酶阳性大肠埃希菌及肺炎克雷白杆菌、耐甲氧西林金黄色葡萄球菌、肺炎链球菌耐药率无明显变化。细菌分析及耐药性监测对指导临床危重患儿的抗感染治疗有重要意义。Objective To analyze the five years change of bacterial infection and drug resistance in PICU and to provide evidence for use of antibiotics rationally. Methods All the pathogenic bacteria from patients in PICU of our hospital from January 1 2009 to December 31 2013 were analyzed retrospectively. They were divided into five subgroups according to different years. Pathogenic bacteria and drug resistance in different years were collected and the changes of such bacterial infection and drug resistance were compared and summarized. Results A total of 2 201 pathogenic bacterial strains were isolated from 14 361 specimens of five-year patients in PICU. The rate of gram negative bacteria in 2009 to 2013 were 83.2% ,71.0%, 59. 8% ,58.9%, 52. 5% respectively. The rate of gram positive bacteria in 2009 to 2013 were 16. 8%, 29. 0% ,40. 2%, 41.1%, 47. 5% respectively. Top five pathogenic bacteria were staphylococcus aureus （ 16. 6% ,366 strains） ,Escherichia coli （ 16. 2% ,357 strains） ,klebsiella pneumoniae （ 15.2% ,334 strains）, streptococcus pneumoniae （9. 2% ,202 strains）, haemophilus influenzae （ 6. 8%, 149 strains）. The infection rate of staphylococcus aureus increased year by year（6.4% to 27.0% ）. Drug sensitivity test indicated that the rate of extended-spectrum beta-lactamases （ESBL） positive escherichia coli and klebsiella pneumoniae were 28.3% and 38.3% ,respectively. The rate of methicillin-resistant staphylococcus aureus （MRSA） was 26. 0%. Based on non-meningitis criterion, rate of penicillin resistance streptococcus pneumonia and multiple- drugresistance streptococcus pneumonia was 19. 3% and 58.9% ,respectively. There were no obvious changes in resistance rate of above-mentioned bacteria during the recent five years. Conclusion In the recent five years, gram negative bacteria is still the prevalent strain in PICU of our hospital, however the rate of gram positive bacteria increases year by year and staphylococcus anreus has become one of the five most common bacteria. The rate o

关 键 词：儿童 重症监护室 细菌感染 耐药性 

分 类 号：R446.5[医药卫生—诊断学]