儿童医院临床分离多重耐药菌的流行病学分析  

Epidemiological Analysis of Clinical Isolation of Multi-drug Resistant Bacteria in Children’s Hospitals

作　　者：陈丽琴 李亚玲[1] 李小娟[1] 韩永慧 李伟杰[1] CHEN Liqin;LI Yaling;LI Xiaojuan;HAN Yonghui;LI Weijie(Dept.of Infection Management,Kunming Children’s Hospital,Kunming Yunnan 650100,China)

机构地区：[1]昆明市儿童医院感染管理科,云南昆明650100

出　　处：《昆明医科大学学报》2022年第1期40-47,共8页Journal of Kunming Medical University

基　　金：昆明市卫生健康委卫生科研基金资助项目(2020-12-03-001);昆明市儿童医院卫生管理类基金资助项目(2020-XZ-11)。

摘　　要：目的分析某儿童医院临床分离多重耐药菌的分布情况及耐药特点,为医院多重耐药菌的预防和治疗提供临床依据。方法采用回顾性分析方法,收集2018年1月至2020年12月某儿童医院住院患者送检标本临床分离病原菌中排名前5位的多重耐药菌检出结果等资料,了解检出多重耐药菌的患儿年龄、性别、科室分布情况并进行耐药性分析。结果 3 a间临床分离1 451株多重耐药菌,排名前5位的依次为产ESBLs大肠埃希菌、MRSA、产ESBLs肺炎克雷伯菌、CRAB、CRKP。各年度产ESBLs大肠埃希菌、MRSA、产ESBLs肺炎克雷伯菌的检出率差异无统计学意义(P=0.163、P=0.125、P=0.174),CRAB检出率先升高后下降(P <0.001), CRKP的检出率呈逐年下降(P=0.001)。检出多重耐药菌的患儿以男童(占55.4%),婴儿(43.6%)为主;检出率最高的科室为神经外科,为9.18%,其次是烧伤整形外科,检出率为4.32%;标本种类以分泌物阳性率最高,为7.06%。药敏结果显示:产ESBLs大肠埃希菌对青霉素类及头孢唑林、头孢曲松抗菌药物的耐药率大于99%。MRSA对青霉素类的耐药率为100%,对万古霉素、利奈唑胺、替加环素的耐药率均为0.0%。产ESBLs肺炎克雷伯菌对青霉素类及头孢唑林、头孢曲松抗菌药物的耐药率为100.0%。2018年鲍曼不动杆菌除对美罗培南的耐药率为16.7%外,对其余13种抗菌药物的耐药率均为100.0%,2019年与2020年鲍曼不动杆菌除对呋喃妥因、头孢唑林、氨苄西林的耐药率为100.0%,对其余抗生素的耐药率均低于2018年。CRKP对青霉素类、头孢菌素类及碳青霉烯类抗生素的耐药率均在90.0%以上。结论近年来儿童医院多重耐药菌耐药形势严峻,应加强临床抗菌药物合理使用的管理,减少耐药菌的发生。Objective To analyze the distribution and characteristics of multi-drug-resistant bacteria isolated from the clinic in a children’s hospital,providing the clinical evidence for the prevention and treatment of multi-drug-resistant bacteria in the hospital. Methods A retrospective analysis method was used to collect the data of the top five multi-drug-resistant bacteria of clinically isolated pathogens from inpatients in a children’s hospital from January 2018 to December 2020,to understand the age,sex,and department distribution in children of multi-drug resistance bacteria,and analyze the drug resistance. Results 1 451 strains of multi-drug resistant bacteria were clinically isolated in three years,and the top five were ESBLs-producing Escherichia coli,MRSA,ESBLs-producing Klebsiella pneumoniae, CRAB, and CRKP. The detection rates of ESBLs-producing Escherichia coli,MRSA,and ESBLs-producing Klebsiella pneumoniae were not statistically different in each year (P = 0.163,P = 0.125,P = 0.174),and the detection rate of CRAB first increased and then decreased( P <0.001),the detection rate of CRKP was decreasing year by year(P = 0.001). The majority of children with multidrug-resistant bacteria were boys(55.4%) and infants(43.6%). The department with the highest detection rate was neurosurgery,with 9.18%,followed by burn plastic surgery,with a detection rate of 4.32%;specimen types had the highest positive rate of secretion,which was 7.06%. The main type of specimens was sputum(52.3%). The drug sensitivity results showed that the resistance rates of ESBLs-producing Escherichia coli to penicillins,cefazolin and ceftriaxone were greater than 99%. The resistance rate of MRSA to penicillins was 100%,and the resistance rates to vancomycin,linezolid,tigecycline were all 0.0%. The resistance rates of ESBLs-producing Klebsiella pneumoniae to penicillins,cefazolin and ceftriaxone were 100.0%. In 2018,the resistance rate of Acinetobacter baumannii to meropenem was 16.7%,and the resistance rates to the other 13 antibacterial d

关 键 词：儿童医院 多重耐药菌 流行病学 

分 类 号：R373.2[医药卫生—病原生物学]