某三甲医院儿童产ESBLs大肠埃希菌临床分布及耐药性分析  

Clinical Distribution and Analysis of the Resistance of Producing ESBLs Escherichia Coli of Children in a Grade A Tertiary Hospital

作　　者：邱小梅[1] 刘东才[1] 冯桂玲[1] 赵芳[1] 古艳芳[1] 汪锡文[1] 徐鹏[1] 

机构地区：[1]中山市博爱医院,广东中山528403

出　　处：《药物流行病学杂志》2016年第11期711-715,共5页Chinese Journal of Pharmacoepidemiology

基　　金：中山市科学技术局基金项目(编号:2014A1FC143)

摘　　要：目的：研究某三甲医院0～14岁儿童产超广谱β-内酰胺酶（ESBLs）大肠埃希菌的临床特征及耐药性，为指导临床合理使用抗菌药提供依据。方法：收集2013年1月-2015年12月住院患儿确诊产ESBLs大肠埃希菌数据，对临床分离株数、来源、科室分布、检出率及耐药率进行分析。结果：3年共分离大肠埃希菌1187株，检出ESBLs555株，总检出率46．76％。2013—2015年每年产ESBLs大肠埃希菌检出率分别是45．18％，54．04％，44．20％；2013～2014年儿科检出率最高是新生儿重症监护病房（NICU）和儿科重症监护病房（PICU），可达95％～100％，2015年明显下降至63％左右；菌株主来源于痰液〉中段尿〉血液〉其他；分布居前三位分别是小儿呼吸内科、小儿泌尿内科及PICU；产ESBLs大肠埃希菌对大部分青霉素及头孢菌素类耐药率〉85％；对头孢他啶、氨曲南、复方磺胺甲噁唑、氨苄西林／舒巴坦、庆大霉素的耐药率〉30％；而对头孢吡肟的耐药率〈20％，对哌拉西林／他唑巴坦、头孢替坦、阿米卡星、碳青霉烯类的耐药率≤3％。结论：产ESBLs大肠埃希菌在儿科分布较广，部分儿科科室检出率仍较高，对碳青霉烯类、头霉素类等药物敏感，临床应注意合理使用。Objective： To analysis clinical features and resistance of producing ESBLs Escherichia coli of 0-14 years inpatients in a grade a tertiary hospital, and to provide the basis for guiding clinical rational use of antimicrobial agents. Methods： Clinical data of producing ESBLs Escherichia coli, diagnosed in our hospital neonatal and pediatric inpatient from January 2013 to December 2015, including the distribution department, source of specimen, the number of strain, the positive rate and resistance rates, were collected and analyzed. Results：A totle of 1 187 strains of Escherichia coli were cultured from patients, in which 555 （46.76%） strains were producing ESBLs, in three years. Constituent ratio of producing ESBLs Escherichia coli was 45.18%, 54.04%, 44.20% respectively in 2013-2015. In 2013-2014, NICU and PICU were the highest positive rate in all pediatric ward, the positive rate was up to 95% to 100%, but significantly decreased to around 63% in 2015. The main source of specimen strain producing ESBLS order was sputum 〉 urine 〉 blood 〉 other. The children＇s respiratory medicine, urology and PICU were top three distribution departments. Production ESBLs Escherichia coli showed high-level resistance to commonly used antibiotics, resistance rates of penicillins and cephalosporins were more than 85%, resistance rates of ceftazidime, aztreonam, trimethoprim-sulfamethoxazole, ampicillin/sulbactam, gentarniein were more than 30% ,resistance rates of cefepime was less than 20%, resistance rates of piperacillin/tazobactam, eefotetan, amikaein, carbapenems were less than or equal to 3%. Conclusion： Producing ESBLs Escherichia coli were widely distributed in pediatric ward. Some pediatric ward positive rate is still high, and sensitive to earbapenems, head of ADM. It should be rational use antibiotics in clinical.

关 键 词：儿童 产超广谱Β-内酰胺酶大肠埃希菌 临床分布 耐药率 

分 类 号：R398.21[医药卫生—基础医学]