重症监护病房儿童腹腔感染相关脓毒症临床分离菌及耐药性分析  

Distribution and antibiotic resistance of pathogen isolated from children with intra-abdominal infection associated sepsis in intensive care unit

作　　者：张贝贝 胡蕾[1] 周明明[2] 叶璟[1] 高彩娜 管丽君 鲍益耀 谈林华[1] Zhang Beibei;Hu Lei;Zhou Mingming;Ye Jing;Gao Caina;Guan Lijun;Bao Yiyao;Tan Linhua(Department of Surgery Intensive Care Unit,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310056,China;Department of Clinical Laboratory,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310056,China)

机构地区：[1]浙江大学医学院附属儿童医院外科重症监护室,国家儿童健康与疾病临床医学研究中心,杭州310056 [2]浙江大学医学院附属儿童医院实验检验中心,国家儿童健康与疾病临床医学研究中心,杭州310056

出　　处：《中国小儿急救医学》2024年第2期107-113,共7页Chinese Pediatric Emergency Medicine

摘　　要：目的分析重症监护病房(ICU)儿童腹腔感染(IAI)相关脓毒症临床分离菌分布及耐药性,为儿童IAI经验性抗感染治疗提供参考。方法回顾性分析2019年1月至2021年12月浙江大学医学院附属儿童医院收治的116例病原菌培养阳性的ICU IAI相关脓毒症患儿的病例资料,按照不同的发病年份、发病地点、原发疾病,进行临床分离菌及耐药性分析。结果共收集ICU儿童IAI相关脓毒症病原菌186株,革兰阳性菌、革兰阴性菌以及真菌的占比分别为53.2%、40.9%、5.9%;屎肠球菌、大肠埃希菌、肺炎克雷伯菌、粪肠球菌是居前4位的分离菌,占所有分离菌株的57.0%;革兰阳性菌常见屎肠球菌(19.9%)、粪肠球菌(10.2%);革兰阴性菌多见大肠埃希菌(13.4%)、肺炎克雷伯菌(13.4%);真菌以白色念珠菌(3.8%)为主。61例感染性疾病患儿培养出革兰阳性菌57株,主要为屎肠球菌(28株);革兰阴性菌53株,以肺炎克雷伯菌(21株)为主;40例消化道畸形患儿培养出革兰阳性菌32株,粪肠球菌(6株)最常见;革兰阴性菌14株,主要为大肠埃希菌(6株);13例消化系统恶性肿瘤患儿培养出革兰阳性菌9株,屎肠球菌(4株)最多见;革兰阴性菌8株,主要为大肠埃希菌(4株)。46例社区获得性IAI患儿培养出革兰阳性菌30株,主要为屎肠球菌(12株)、表皮葡萄球菌(7株)、草绿色链球菌(6株);革兰阴性菌40株,主要为大肠埃希菌(16株)、肺炎克雷伯菌(14株)、阴沟肠杆菌(5株)。70例医院获得性IAI患儿培养出革兰阳性菌69株,主要为屎肠球菌(25株)、粪肠球菌(17株)、鹑鸡肠球菌(8株)、金黄色葡萄球菌(7株);革兰阴性菌36株,主要为肺炎克雷伯菌(11株)、大肠埃希菌(9株)、铜绿假单胞菌(4株)、鲍曼不动杆菌(4株)。临床病原菌混合感染率高达46.6%,总体耐药率43.4%,其中,革兰阴性菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南、替加环素敏感率较高。产超广谱β-内酰胺�Objective Distribution and antibiotic resistance of pathogen isolated from children with intra-abdominal infection(IAI)associated sepsis in the intensive care unit(ICU)were analyzed to provide a reference for the empirical anti-infective treatment of IAI in children.Methods We retrospectively analyzed the data of 116 children with culture-positive IAI-associated sepsis admitted to Children's Hospital of Zhejiang University School of Medicine from January 2019 to December 2021.Clinical isolation and drug resistance analysis were conducted based on different years of onset,locations of onset,and primary diseases.Results A total of 186 strains of pathogens causing children with IAI-associated sepsis in ICU were collected.The distribution and antibiotic resistance of pathogen were as follows:the percentages of gram-positive bacteria,gram-negative bacteria,and fungi were 53.2%,40.9%,and 5.9%,respectively;the top four strains were Enterococcus faecium,Escherichia coli,Klebsiella pneumoniae,and Enterococcus faecalis,accounting for 57.0%of all isolates;Enterococcus faecium(19.9%)and Enterococcus faecalis(10.2%)were the dominating gram-positive bacteria;Escherichia coli(13.4%)and Klebsiella pneumoniae(13.4%)were more common gram-negative bacteria;Fungi were dominated by Candida albicans(3.8%).Fifty-seven strains of gram-positive bacteria were detected in 61 children with infectious diseases,mainly Enterococcus faecium(28 strains).There were 53 gram-negative strains,mainly Klebsiella pneumoniae(21 strains).Thirty-two strains of gram-positive bacteria were detected in 40 children with digestive tract malformation,and Enterococcus faecalis(six strains)were the most common.There were 14 gram-negative strains,mainly Escherichia coli(six strains).In 13 children with malignant tumors of digestive system,nine strains of gram-positive bacteria were cultured,and Enterococcus faecium(four strains)was the most common.There were eight gram-negative strains,mainly Escherichia coli(four strains).In the 46 community-acquired IAI patients

关 键 词：儿童 腹腔感染 脓毒症 病原菌 耐药性 重症监护病房 

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