某儿童医院2012-2014年多重耐药菌的分布及趋势研究  

Research on distribution of multidrug-resistant organisms and trend of antibiotic resistance in a children's hospital from 2012 to 2014

作　　者：洪礼义[1] 赵旭[1] 严向明[1] 朱宏[1] 王秀珍[1] 彭寒玲[1] 陶云珍[1] 

机构地区：[1]苏州大学附属儿童医院,苏州215025

出　　处：《江苏预防医学》2015年第6期25-28,共4页Jiangsu Journal of Preventive Medicine

摘　　要：目的了解某儿童医院近年来临床分离的多重耐药菌(MDROs)分布及变化趋势。方法回顾性分析2012-2014年从住院患者中分离出的MDROs。结果3年共分离出504株MDROs,其中医院感染88株,以多重耐药铜绿假单胞菌(MDR-PA)为主(检出26株,占29.55%)。MDROs的检出率和医院感染率均呈逐年增高趋势(P值均<0.01),2014年MDROs检出率和感染率均最高,分别为1.094%和0.158%。检出的MDROs种类逐年增加(P<0.01),以耐甲氧西林金黄色葡萄球菌(MRSA)为主(占75.79%),主要来自呼吸道分泌物(占88.49%)。临床分离MDROs前3位的科室是新生儿科(27.98%)、呼吸科(26.98%)和ICU(11.11%),种类均以MRSA为主。近年新生儿科分类出的耐碳青霉烯类肺炎克雷伯菌(CRKP)有增多趋势(P<0.01)。3年中检出的MRSA对利奈唑胺、万古霉素和替加环素耐药率均为0,对大部分抗生素耐药率的变化无统计学意义(P>0.05)。2014年CRKP对哌拉西林/他唑巴坦的耐药率有所增加(P<0.01)。结论该儿童医院MDROs检出率及医院感染率逐年增多,且标本来源逐渐多样化、分布更广,应加强住院患儿MDROs管理。Objective To investigate current distribution of multidrug-resistant organisms（MDROs） and trend of antibiotic resistance in a children＇s hospital. Methods A retrospective analysis was conducted on medical records of MDROs isolated from 2012 to 2014. Results A total of 504 strains of MDROs were isolated from patients from 2012 to 2014, including 88 nosocomial infection strains , among which Pseudomonas aeruginosa （MDR-PA） were predominant strains（26 strains, accounting for 29.55%）. Both the detection rate and nosocomial infection rate of MDROs increased every year （all P〈0. 01）. Both rates were highest in 2014： 1. 094 % for detection and 0. 158 % for infection. The annual detected species of MDROs increased every year （P 〈0. 01）, MRSA was the major MDROs （75.79 %） and strains were mainly isolated from respiratory secretions （88. 49 % ）. Neonatal departments （27.98% ）, respiratory departments （26.98% ） and ICU （11.11% ） were top 3 clinical departments for MDROs isolates, MRSA was still the major species. However, detection of carbapenem-resistant Klebsiella pneumoniae （CRKP） in the neonatal ward significantly increased in recent years （P〈0.01）. Drug resistance rates to linezolid, vancomycin and tigecycline of MRSA strains were 0 in past 3 years, with steady resistance rates to majority of antibiotics（P〉0.05）. However, CRKP＇s resistance rate to piperacillin / tazobactam increased in 2014（P〈0.01）. Conclusion Both the detection rate and nosocomial infection rate of MDROs increased every year in the children＇s hospital, with various sources of specimens and wide distribution. According to characteristics of pediatrics clinics, it is necessary to strengthen the management of MDROs.

关 键 词：儿童 多重耐药菌 耐药性 变化趋势 

分 类 号：R378[医药卫生—病原生物学]