2018—2021年武汉大学人民医院儿童血流感染的病原菌分布特征及耐药性分析  

Analysis on pathogen distribution and drug resistance of children bloodstream infection in Renmin Hospital of Wuhan University from 2018 to 2021

作　　者：蔡璇[1] 田炳秋[2] 施金玲[1] 冯锴[1] 李从荣[1] CAI Xuan;TIAN Bing-qiu;SHI Jin-ling;FENG Kai;LI Cong-rong(Department of Clinical Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Laboratory,Chibi Center for Disease Control and Prevention,Xianning 437300,China)

机构地区：[1]武汉大学人民医院检验科,湖北武汉430060 [2]赤壁市疾病预防控制中心检验科,湖北咸宁437300

出　　处：《现代药物与临床》2022年第6期1355-1360,共6页Drugs & Clinic

基　　金：湖北省卫生厅科研项目(JX6B23);赤壁市重点科技计划项目(2019SF001)。

摘　　要：目的分析武汉大学人民医院儿童血流感染病原菌特征及耐药性分析。方法选取2018年1月—2021年12月武汉大学人民医院患儿血培养标本分离的病原菌及其药物敏感性数据进行统计分析。结果共收集到21571份住院儿童的血培养标本,共分离出病原菌1646株,检测阳性率为7.63%。其中革兰阳性菌910株,占比为55.29%,革兰阴性菌715株,占比43.44%,真菌21株,占比1.28%。儿童血流感染前5位的病原菌依次为肺炎克雷伯菌、表皮葡萄球菌、肺炎链球菌、人葡萄球菌和大肠埃希菌,占比分别为20.60%、15.25%、14.52%、10.69%、10.57%。耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)检出率为20.47%,未发现有万古霉素耐药的凝固酶阴性葡萄球菌。肺炎克雷伯菌产超广谱β-内酰胺酶(ESBL)阳性占比为74.93%,大肠埃希菌ESBL阳性占比为6.90%;耐碳青霉烯酶的肠杆菌目(CRE)大肠埃希菌占比为56.32%,CRE肺炎克雷伯菌占比为0%。肺炎链球菌对红霉素、克林霉素、四环素耐药率较高,分别为100.0%、92.9%、85.2%,未发现对莫西沙星、利奈唑胺以及万古霉素耐药菌株。结论武汉大学人民医院儿童血流感染主要菌株为肺炎克雷伯菌、肺炎链球菌和凝固酶阴性葡萄球菌(CNS),且CNS耐药性较高,肺炎克雷伯菌对第3代头孢有了较高耐药性。应加强医院儿童耐药菌株监测,合理使用抗菌药物。Objective To analyze the characteristics and drug resistance of pathogenic bacteria of children bloodstream infection in Renmin Hospital of Wuhan University.Methods The data of pathogenic bacteria and drug sensitivity isolated from blood culture samples of children in Renmin Hospital of Wuhan University from January 2018 to December 2021 were selected for statistical analysis.Results A total of 21571 blood samples from hospitalized children were collected,and 1646 strains of pathogenic bacteria were isolated,with a positive rate of 7.63%.Among them,910 gram-positive strains accounted for 55.29%,715 gram-negative strains accounted for 43.44%,and 21 fungal strains accounted for 1.28%.The top 5 pathogenic bacteria of children bloodstream infection were Klebsiella pneumoniae,Staphylococcus epidermidis,Streptococcus pneumoniae,Staphylococcus hominis and Escherichia coli,accounting for 20.60%,15.25%,14.52%,10.69%,and 10.57%,respectively.The detection rate of methicillin-resistant coagulase negative staphylococcus(MRCNS)was 20.47%,and no coagulase negative staphylococcus resistant to vancomycin was found.The ESBL positive rate of Klebsiella pneumoniae was 74.93%,ESBL positive rate of Escherichia coli was 6.90%.Carbapenemase-resistant Enterobacteriaceae(CRE)Escherichia coli accounted for 56.32%,CRE Klebsiella pneumoniae accounted for 0%.The drug resistance rates of Streptococcus pneumoniae to erythromycin,clindamycin and tetracycline were 100.0%,92.9%,and 85.2%,respectively.No drug resistance strains to moxifloxacin,linezolid and vancomycin were found.Conclusion The main blood stream infection strains of children in Renmin Hospital of Wuhan University were Klebsiella pneumoniae,Streptococcus pneumoniae and coagulase negative staphylococcus(CNS),with high drug resistance of CNS,and Klebsiella pneumoniae had high drug resistance to the third generation cephalosporin.It is necessary to strengthen the monitoring of drug-resistant strains in hospital children and rationally use antibiotics.

关 键 词：血流感染 儿童 病原菌 耐药分析 肺炎克雷伯菌 肺炎链球菌 凝固酶阴性葡萄球菌 

分 类 号：R978.1[医药卫生—药品]