住院患儿血流感染586例病原菌分布及耐药性分析  

Bacteriological profile and antibiogram of 586 cases of paediatric inpatient with bloodstream infections

作　　者：吴沪军 温顺航[1] 张渊博[1] 钟佩佩[1] 李昌崇[1] 郭书真 刘榴[1] 林罗娜 

机构地区：[1]温州医科大学附属育英儿童医院呼吸科,浙江温州325000

出　　处：《中国实用儿科杂志》2015年第6期431-435,共5页Chinese Journal of Practical Pediatrics

基　　金：浙江省自然科学基金资助项目(NO:LZ13H010001)

摘　　要：目的了解血流感染患儿致病菌的流行分布及耐药情况,为临床合理选择抗菌药物提供依据。方法收集温州医科大学附属育英儿童医院2007年1月至2013年12月临床确诊为血流感染的住院患儿,分析其病原菌和对抗菌药物的耐药情况。结果 7年间血流感染患儿病原菌以革兰阴性菌为主,占52.1%;革兰阳性菌和真菌分别占44.0%和3.9%。主要的致病菌依次为大肠埃希菌、金黄色葡萄球菌、粪肠球菌、肺炎克雷伯菌。新生儿和婴儿血流感染的主要致病菌为大肠埃希菌,1~5岁患儿以肺炎链球菌为主,〉5岁患儿以金黄色葡萄球菌感染为主。耐药分析显示,50%以上的大肠埃希菌和70%以上的肺炎克雷伯菌对第3代头孢菌素耐药。金黄色葡萄球菌对苯唑西林的耐药为31.8%,另检出对万古霉素耐药的耐甲氧西林金黄色葡萄球菌1例。结论本文血流感染以革兰阴性菌为主,主要的致病菌依次为大肠埃希菌、金黄色葡萄球菌、粪肠球菌。不同年龄段致病菌分布各不相同。目前儿科血流感染患儿致病菌对常用抗菌药物存在着严重的耐药性。Objective To investigate the epidemiology of paediatric inpatients with bloodstream infections, identify the pathogen spectrum and antibiotics susceptibility to provide the basis for judicious therapeutic antimicrobial use in clinic. Methods Between January 2007 and December 2013, we enrolled children with diagnosed bacteremia, analyzed the dis- tribution of pathogenic bacteria and its antimicrobial resistance. Results In the past seven years, the majority of organism was gram-negative species which accounted for 52.1%, gram-positive species and fungi were 44.0% and 3.9% respectively. Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus and Enterococcus were the common pathogens. E.coli was the most common pathogen among neonates and infants bloodstream infections. Streptococcus pneumonia was common in children aged 1 year to 5 years. S.aureus was common in older children（ 〉 5yr）. A third-generation cephalosporin resistance was common among E.coli （ 〉 50%） and Klebsiella （ 〉 70%）. About 31.8% Staphylococcus aureus resist to oxacillin and a case of vancomycin resistance SA was showed in our research. Conclusion The gram-negative species are the predominant pathogens in our region. The most common isolates is Escherichia coli ,followed by Staphylococcus aureus, Enterococcus. Nowadays, the incidence of antimicrobial resistance in the peadiatric bloodstream infections are serious.

关 键 词：血流感染 病原菌 耐药 抗菌药物 

分 类 号：R72[医药卫生—儿科]