儿童患者呼吸机相关肺炎病原菌的耐药监测  

Surveillance of drug resistance in pathogens of child patients with ventilator-associated pneumonia

作　　者：夏尊恩[1] 周泉[1] 吴青[1] 

机构地区：[1]武汉大学人民医院检验科,湖北武汉430060

出　　处：《职业与健康》2016年第23期3217-3220,共4页Occupation and Health

基　　金：国家临床重点专科建项项目(2010305)

摘　　要：目的探讨大型综合医院新生儿呼吸机相关肺炎的病原菌构成及耐药情况。方法收集2012年6月—2016年6月在武汉大学人民医院接受治疗的儿童患者呼吸机相关肺炎痰液标本,接种于血琼脂平皿及巧克力平皿上并挑取可疑菌落采用BD Phoenix TM 100全自动细菌鉴定药敏系统进行检测,并采用纸片法补充部分进行药敏试验,采用Whonet 5.6软件处理数据。结果 696份痰标本阳性标本478例,分离出病原菌336株,其中革兰阴性菌233株（69.35%）,以绿脓杆菌、鲍氏不动杆菌、肺炎杆菌和大肠杆菌为主;革兰阳性菌86株（25.60%）,以金黄色葡萄球菌、表皮葡萄球菌、肠球菌为主;真菌17株（5.06%）,以白色念珠菌为主。绿脓杆菌对环丙沙星、庆大霉素、氯霉素和四环素抗菌药物的耐药率均超过54%;鲍氏不动杆菌对哌拉西林、环丙沙星、左氧氟沙星抗生素的耐药率均超过91%;肺炎杆菌和大肠杆菌都对氨苄西林抗生素的耐药率最高为93.9%和93.5%,且超广谱β-内酰胺酶（ESBLs）检出率分别为36.4%和19.4%,差异无统计学意义（χ^2=2.29,P〉0.05）。金黄色葡萄球菌、表皮葡萄球菌、肠球菌均对青霉素的耐药率最高分别为90.0%、100.0%、100.0%。革兰阳性球菌未检出万古霉素和利奈唑胺耐药;金黄色葡萄球菌和表皮葡萄球菌的苯唑西林的耐药率相比,差异有统计学意义（χ^2=11.42,P〈0.05）。结论革兰阴性杆菌是导致儿童患者呼吸机相关肺炎最主要的病原菌,对常用抗菌药物的耐药情况复杂多样,严格消毒机械通气设备,加强其病原菌的耐药性监测,合理使用抗菌药物,对指导临床合理用药具有重要意义。[Objective]To explore the pathogenic bacteria composition and drug resistance status of neonatal ventilator-associated pneumonia in large general hospital. [Methods]The sputum samples were collected from child patients with ventilator-associated pneumonia,who were treated in Renmin Hospital of Wuhan University from June 2013 to June 2016,and were inoculated on blood agar plates and chocolate plates. The suspected colonies were tested by BD Phoenix TM 100 automatic bacteria identification system. The susceptibility testing was performed by the complementary part of the disk diffusion method,and the data were analyzed by Whonet 5.6 software.[Results]478 of 696 sputum samples were positive,and 336 pathogens were isolated,including233 strains of Gram-negative bacteria（69.35%）,which were dominated by Pseudomonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae and Escherichia coli, 86 strains of Gram-positive bacteria（25.60%）, which were dominated by Staphylococcus aureus,Staphylococcus aureus and Enterococcus,and 17 strains of fungus（5.06%）,which was mainly Candida albicans. The resistance rates of Pseudomonas aeruginosa to ciprofloxacin,gentamicin,chloramphenicol and tetracycline were higher than 54%,the resistance rates of Acinetobacter baumannii to piperacillin,ciprofloxacin,levofloxacin were higher than 91%,the resistance rate of Klebsiella pneumoniae and Escherichia coli to ampicillin was 93.9% and 93.5% respectively,while the detection rate of ESBLs was 36.4 % and 19.4% respectively,and the difference was not statistically significant（χ^2=2.29,P〉0.05）.The resistance rate of Staphylococcus aureus,Staphylococcus aureus and Enterococcus to penicillin was 90.0%,100.0% and 100.0%,respectively. Gram-positive bacteria cocci were sensitive to vancomycin and linezolid. There was statistically significant difference in resistance rate of Staphylococcus aureus,and Staphylococcus aureus to oxacillin（χ^2 =11.42,P〈0.05）.[Conclusion]Gram-negative bacteria are the main pathogens of child patie

关 键 词：儿童 呼吸机相关肺炎 病原菌 耐药监测 

分 类 号：R446[医药卫生—诊断学]