小儿先天性心脏病外科术后感染病原菌分布及耐药性分析  

Distribution and drug resistance analysis of pathogenic bacteria in children with congenital heart disease after surgery

作　　者：高简 王晓聪 李俊贤 康金锁 GAO Jian;WANG Xiaocong;LI Junxian;KANG Jinsuo(Department of Clinical Laboratory,Yunnan Fuwai Cardiovascular Hosptial,Kunming,Yunnan 650000,China;Laboratory Diagnostic Center,Fuwai Hospital,Peking Union Medical College of Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]云南省阜外心血管病医院检验科,云南昆明650000 [2]中国医学科学院协和医学院阜外医院实验诊断中心,北京100037

出　　处：《检验医学与临床》2023年第3期294-298,共5页Laboratory Medicine and Clinic

基　　金：云南省心血管病临床医学中心项目(FZX2019-06-01)。

摘　　要：目的分析先天性心脏病(CHD)患儿外科术后感染病原菌分布及耐药性,为临床合理使用抗菌药物提供依据。方法选取2020年8月至2022年3月就诊于云南省阜外心血管病医院儿科重症监护室小儿心脏外科且术后发生感染的CHD患儿作为研究对象。从送检标本分离所得的符合条件的病原菌118株,分析其分布及耐药性。结果118株病原菌中,革兰阳性菌占55.9%(66/118),主要以肺炎链球菌(23.7%)、金黄色葡萄球菌(19.5%)、屎肠球菌(5.1%)为主,对万古霉素、替考拉宁、利奈唑胺及替加环素的耐药率为0.0%;革兰阴性菌占35.6%(42/118),主要以肺炎克雷伯菌(8.5%)、大肠埃希菌(6.8%)、嗜麦芽窄食单胞菌(6.8%)、鲍曼不动杆菌(5.1%)为主,对替加环素均敏感,肺炎克雷伯菌对常见抗菌药物的耐药率比大肠埃希菌高,嗜麦芽窄食单胞菌对复方磺胺甲噁唑、左氧氟沙星及米诺环素均未出现耐药;真菌占8.5%(10/118),主要以近平滑假丝酵母菌为主。结论革兰阳性菌是CHD患儿外科术后感染的主要病原菌,呼吸道是常见感染部位,不同种类的病原菌对不同抗菌药物表现出不同程度的耐药性,应根据药敏试验结果合理选择抗菌药物。Objective To analyze the distribution and drug resistance of pathogenic bacteria in children with congenital heart disease(CHD)after surgery,and to provide an important basis for rational clinical use of antibiotics.Methods A total of 118 strains of pathogenic bacteria were isolated from the specimens of children with CHD,who were infected after the cardiac surgery in PICU of Fuwai Yunnan Cardiovascular Hosptial from August 2020 to March 2022,and the distribution and drug resistance of pathogenic bacteria were analyzed.Results Among 118 strains of pathogenic bacteria,Gram-positive bacteria accounted for 55.9%(66/118),mainly Streptococcus pneumoniae(23.7%),Staphylococcus aureus(19.5%)and Enterococcus faecium(5.1%).The drug resistance rate of Gram-positive bacteria to Vancomycin,Teicoplanin,Linezolid and Tegecycline was 0.0%.Gram-negative bacteria accounted for 35.6%(42/118),mainly Klebsiella pneumoniae(8.5%),Escherichia coli(6.8%),Stenotrophomonas maltophilia(6.8%)and Acinetobacter baumannii(5.1%),all the Gram-negative bacteria was sensitive to Tigecycline.The resistance rate of Klebsiella pneumoniae to common antibiotics was higher than that of Escherichia coli,while Stenotrophomonas maltophilia showed no drug resistance to compound sulfamethoxazole,Levofloxacin and Minocycline.Fungi accounted for 8.5%(10/118),and Candida parapsilosis was dominant.Conclusion Gram-positive bacteria are the main pathogenic bacteria of postoperative infection in children with CHD,and the respiratory tract is the common infection site.Different kinds of pathogenic bacteria show different degrees of resistance to different antibacterial drugs,so antibacterial drugs should be rationally selected according to the results of drug sensitivity test.

关 键 词：先天性心脏病 外科手术 病原菌 耐药性 

分 类 号：R978.1[医药卫生—药品] R446.5[医药卫生—药学]