单中心五年儿童重症监护病房细菌学监测及耐药性分析  

Bacteriological monitoring and bacterial resistance analysis during five years in single center pediatric intensive care unit

作　　者：许从磊 李晓梅[2] 桑义 赵晓霞 李昭伦 Xu Conglei;Li Xiaomei;Sang Yi;Zhao Xiaoxia;Li Zhaolun(Binzhou Medical University,Binzhou 256600,China;Pediatric Intensive Care Unit,Affliated Hospital of Binzhou Medical College,Binzhou 256600,China;Department of Childrens'Blood and Endocrine,Affiliated Hospital of Binzhou Medical College,Binzhou 256600,China)

机构地区：[1]滨州医学院,256600 [2]滨州医学院附属医院儿童重症医学科,256600 [3]滨州医学院附属医院儿童血液与内分泌科,256600

出　　处：《中国小儿急救医学》2023年第4期291-296,共6页Chinese Pediatric Emergency Medicine

基　　金：山东省省级临床重点专科学科建设资助项目(SLCZDZK-1405)。

摘　　要：目的分析近5年我院PICU病原菌组成及耐药性特点,指导临床合理用药。方法回顾性分析2016年1月至2020年12月滨州医学院附属医院PICU所有标本培养阳性结果,按标本来源、菌株类型及药敏结果进行分类,了解PICU病原学谱及细菌耐药性特点。结果2016年1月至2020年12月,PICU送检标本中共分离出病原菌800株,其中革兰阴性菌476株(59.50%),革兰阳性菌292株(36.50%),真菌32株(4.00%)。排名前9位的细菌分别为:金黄色葡萄球菌134株(16.75%)、流感嗜血杆菌79株(9.88%)、肺炎克雷伯菌78株(9.75%)、肺炎链球菌74株(9.25%)、大肠埃希菌56株(7.00%)、鲍曼不动杆菌51株(6.38%)、卡他莫拉菌48株(6.00%)、阴沟肠杆菌26株(3.25%)、铜绿假单胞菌25株(3.13%)。药敏结果示超广谱β-内酰胺酶阳性的大肠埃希菌及肺炎克雷伯菌分别为27株(48.21%,27/56)、42株(53.85%,42/78),耐甲氧西林金黄色葡萄球菌24株(17.91%,24/134);金黄色葡萄球菌对青霉素G、氨苄西林几乎100%耐药,对克林霉素、红霉素也有较高的耐药率,分别为72.70%、72.30%,对米诺环素、替考拉宁、万古霉素、利奈唑胺、达托霉素100%敏感;肺炎链球菌对红霉素、克林霉素的耐药率分别为98.60%和98.50%,对阿奇霉素的耐药率高达96.80%,对青霉素G、头孢噻肟、头孢曲松耐药率较低,分别为12.30%、5.40%和1.50%,对莫西沙星、利奈唑胺、万古霉素100%敏感。结论近5年我院PICU病原学以革兰阴性菌为主,最常见的致病菌是金黄色葡萄球菌。肺炎克雷伯菌和大肠埃希菌感染仍然是巨大挑战。应加强细菌耐药性监测,为临床合理使用抗菌药物提供依据。Objective The characteristics of bacteriology and the change of drug resistance in PICU of our hospital during recent 5 years were analyzed to guide clinical rational drug use.Methods All positive results of bacterial culture in PICU from January 2016 to December 2020 were retrospectively analyzed,and were classified according to the sample source,strain type and drug sensitivity results.The bacterial etiology spectrum and drug resistance in PICU were summarized.Results A total of 800 pathogenic bacteria were isolated from the specimens collected from the PICU from January 2016 to December 2020,including 476 Gram-negative bacteria,292 Gram-positive bacteria,and 32 fungi,accounting for 59.50%,36.50%,and 4.00%,respectively.The top 9 bacteria were:Staphylococcus aureus 134(16.75%),Haemophilusinfluenzae 79(9.88%),Klebsiellapneumoniae 78(9.75%),Streptococcus pneumoniae 74(9.25%),Escherichia coli 56(7.00%),Acinetobacterbaumannii 51(6.38%),Moraxella catarrhalis 48(6.00%),Enterobacter cloacae 26(3.25%),Pseudomonas aeruginosa 25(3.13%).Drug sensitivity results showed that 27(48.21%,27/56)strains of EScherichia coli and 42(53.85%,42/78)strains of Klebsiella pneumoniae were positive for ultrawide spectrumβ-lactamase,and a total of 24(17.91%,24/134)strains of methicillin-resistant Staphylococcus aureus were detected.Staphylococcus aureus was almost 100%resistant to penicillin G and ampicillin,and had high resistance rates to clindamycin and erythromycin(72.70%and 72.30%,respectively).It was 100%sensitive to minocycline,teicoranin,vancomycin,linezolid,and dattomycin.The drug resistance rates of Streptococcus pneumoniae to erythromycin and clindamycin were 98.60%and 98.50%,respectively.The drug resistance rates to azithromycin were 96.80%,the drug resistance rates to penicillin G,cefotaxime and ceftriaxone were 12.30%,5.40%and 1.50%,respectively,and the drug resistance rates to moxifloxacin,linezolid and vancomycin were 100%sensitive.Conclusion During the past five years,the etiology of the PICU in our hospital is mainly Gram

关 键 词：儿童重症监护病房 病原学 细菌耐药性 

分 类 号：R720.597[医药卫生—急诊医学] R446.5[医药卫生—儿科]