某三甲医院儿童重症监护室细菌分布及耐药性分析  

Analysis of Bacterial Distribution and Drug Resistance of PICU in A Grade-A Tertiary Hospital

作　　者：林丹彤 李奔 刘铜林[1] 熊鹏[1] 黄浩[1] 袁义[1] 陈萍[1] 付丽娜[1] 陈瑜[1] LIN Dantong;LI Ben;LIU Tonglin;XIONG Peng;HUANG Hao;YUAN Yi;CHEN Ping;FU Lina;CHEN Yu(Department of Pediatric Intensive Care Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Neonatal,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]华中科技大学同济医学院附属同济医院儿童重症医学科,武汉430030 [2]湖南省儿童医院新生儿科,长沙410007

出　　处：《医药导报》2022年第12期1860-1864,共5页Herald of Medicine

摘　　要：目的分析儿童重症监护室(PICU)常见细菌分布特点和耐药性,为临床合理使用抗菌药物提供依据。方法回顾性研究2013年1月1日-2021年12月31日某三甲医院PICU微生物培养结果,统计分析该PICU常见病原菌的分布特点和耐药性。结果9年共培养分离细菌1284株,革兰阳性(G^(+))菌385株(30.0%),其中金黄色葡萄球菌和肺炎链球菌最常见。革兰阴性(G^(-))菌899株(70.0%),其中肺炎克雷伯菌、不动杆菌属、流感嗜血杆菌最常见。细菌耐药性分析发现:克雷伯菌属产ESBLs菌株占55.9%,对青霉素和头孢类耐药率达到40.0%,对美洛培南、亚胺培南的耐药率高达41.0%和39.7%;大肠埃希菌产ESBLs菌株占57.3%,对含β-内酰胺酶抑制剂的青霉素类和头孢类抗菌药物耐药率低;鲍曼不动杆菌总体耐药率较高,碳青霉烯类抗菌药物的耐药率也高达57.2%;铜绿假单胞菌对复方磺胺甲·唑耐药率达到95.1%,米诺环素达到67.9%;流感嗜血杆菌ESBLs菌株的检出率为53.8%,对复方磺胺甲·唑(61.2%)和氨苄西林(55.6%)耐药率高;耐甲氧西林金黄色葡萄球菌(MRSA)检出率为42.1%,其对青霉素G的耐药率达到了90.0%;肺炎链球菌对红霉素、克林霉素的耐药率分别是96.3%,95.4%。结论PICU细菌耐药形势严峻,需监测PICU细菌分布及耐药情况,这对早期合理使用抗菌药物有重要意义,根据病情变化及时降阶调整也是减少细菌耐药的重要手段。Objective The distribution characteristics and drug resistance of bacteria in the pediatric intensive care unit(PICU)were analyzed to provide a basis for the rational use of antibiotics.Methods The results of microbial culture in the pediatric intensive care unit of a Grade-A tertiary hospital from January 1,2013,to December 31,2021,and the distribution characteristics and drug resistance of the common pathogens were statistically analyzed.Results 1284 strains of bacteria were isolated in 9 years.There were 385 Gram-positive bacteria(30.0%),of which Staphylococcus aureus and Streptococcus pneumoniae were the most common.There were 899 Gram-negative bacteria(70.0%),of which Klebsiella,Acinetobacter,and Haemophilus influenzae were most common.The analysis of the drug resistances of bacteria:Klebsiella's ESBLs strain ratio was 55.9%.And the drug resistance rates of penicillin and cephalosporin were more than 40%,and the drug resistance rates for meropenem and imipenem were 41.0%and 39.7%.The ratio of Escherichia coli's ESBLs strains was 57.3%,and its resistance rates to penicillin and cephalosporin containingβ-lactamase inhibitors were low.The overall drug resistance rates of Acinetobacter baumannii were high,and its drug resistance rate of carbapenems was 57.2%.The drug resistance rates of Pseudomonas aeruginosa to cotrimoxazole and minocycline were 95.1%and 67.9%.The ratio of Haemophilus influenzae's ESBLs strains was 53.8%,and a high resistance to cotrimoxazole(61.2%)and ampicillin(55.6%).The ratio of MRSA was 42.1%,and its drug resistance rate to penicillin-G reached 90.0%.The drug resistance rates of Streptococcus pneumoniae to erythromycin and clindamycin were 96.3%and 95.4%.Conclusion The situation of bacterial resistance in the PICU is severe,so it is necessary to monitor the distribution and resistance of bacteria in the PICU.Early rational use of antibiotics is of great significance according to the data of bacteria and resistance information,and timely downgrading adjustment according to the changes of d

关 键 词：儿童重症监护室 抗菌药物 细菌耐药性 革兰阳性菌 革兰阴性菌 

分 类 号：R978.1[医药卫生—药品]