2019~2021年河南省患儿血培养分离菌分布及耐药性分析  

Distribution and Antibiotic Resistance Analysis of Blood Culture Isolated Bacteria of Pediatric Patients in Henan Province from 2019 to 2021

作　　者：王健 李轶[2] 马冰[2] 马琼 韩云港[3] 高远[4] 陈甲 李姝 郭长城 郭利敏[7] 赵亮 孟高攀 田育佼[10] 阙蔚鹏 郭坤山 秦辉 孙瑞华 张晓蕾 胡冬梅 张燕 李玉霞[17] 王彦斌 郭瑞娟[19] 孟玉娟 常军玲 张晓黎 熊玲玲 WANG Jian;LI Yi;MA Bing;MA Qiong;HAN Yun-gang;GAO Yuan;CHEN Jia;LI Shu;GUO Chang-cheng;GUO Li-min;ZHAO Liang;MENG Gao-pan;TIAN Yu-jiao;QUE Wei-peng;GUO Kun-shan;QIN Hui;SUN Rui-hua;ZHANG Xiao-lei;HU Dong-mei;ZHANG Yan;LI Yu-xia;WANG Yan-bin;GUO Rui-juan;MENG Yu-juan;CHANG Jun-ling;ZHANG Xiao-li;XIONG Ling-ling(Department of Clinical Laboratory,General Hospital Of PingmeiShenma Medical Group,Pingdingshan 467000,China;Henan Provincial People's Hospital,Zhengzhou 450003,China;Henan Province Chest Hospital,Zhengzhou 450008,China;Yongcheng People's Hospital,Shangqiu 476600,China;Qinyang People's Hospital,Jiaozuo 454550,China;Yellow River Central Hospital,Zhengzhou 450003,China;Xinxiang Central Hospital,Xinxiang 453000,China;Zhoukou Central Hospital,Zhoukou 466000,China;Henan Second Provincial People's Hospital,Zhengzhou 451191,China;Nanyang Central Hospital,Nanyang 473005,China;Henan Children's Hospital,Zhengzhou 450012,China;Xuchang Central Hospital,Xuchang 461000,China;Zhengzhou Yihe Hospital,Zhengzhou 450018,China;Yellow River Sanmenxia Hospital,Sanmenxia 472000,China;Puyang Maternity and Child Health Hospital,Puyang 457000,China;Zhumadian First People's Hospital,Zhumadian 463000,China;Huaihe Hospital of Henan University,Kaifeng 475000,China;Hemei General Hospital,Hebi 458000,China;Puyang People's Hospital,Puyang 457000,China;Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China;Luohe Central Hospital,Luohe 462000,China;Shangqiu Municipal Hospital,Shangqiu 476000,China;Xinyang Traditional Chinese Medicine Hospital,Xinyang 464000,China)

机构地区：[1]平煤神马集团总医院检验科,平顶山467000 [2]河南省人民医院,郑州450003 [3]河南省胸科医院,郑州450008 [4]永城市人民医院,商丘476600 [5]沁阳市人民医院,焦作454550 [6]黄河中心医院,郑州450003 [7]新乡市中心医院,新乡453000 [8]周口市中心医院,周口466000 [9]河南省第二人民医院,郑州451191 [10]南阳市中心医院,南阳473005 [11]河南省儿童医院,郑州450012 [12]许昌市中心医院,许昌461000 [13]郑州颐和医院,郑州450018 [14]黄河三门峡医院,三门峡472000 [15]濮阳市妇幼保健院,濮阳457000 [16]驻马店市第一人民医院,驻马店463000 [17]河南大学淮河医院,开封475000 [18]鹤煤总医院,鹤壁458000 [19]濮阳市人民医院,濮阳457000 [20]郑州大学附属洛阳中心医院,洛阳471000 [21]漯河市中心医院,漯河462000 [22]商丘市立医院,商丘476000 [23]信阳市中医院,信阳464000

出　　处：《中国合理用药探索》2024年第4期53-62,共10页Chinese Journal of Rational Drug Use

基　　金：2023年度河南省医学科技攻关计划联合共建项目(LHGJ20230021)。

摘　　要：目的:了解河南地区患儿血液标本细菌构成情况及耐药性,为临床预防和治疗血流感染提供用药依据。方法:采用WHONET5.6软件,分析2019~2021年河南省临床微生物专科联盟221家单位上报的患儿血培养分离菌的分布及耐药性。结果:2019~2021年共收集患儿血标本非重复分离菌10901株,其中革兰阳性菌占73.1%,革兰阴性菌占26.9%。菌株数量排名前5位的是凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌、肺炎链球菌和肺炎克雷伯菌。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为43.0%,青霉素耐药肺炎链球菌(PRSP)检出率为2.3%;大肠埃希菌对亚胺培南和美罗培南的耐药率分别为2.2%和2.3%,肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为30.4%和28.9%,三级医院的肠杆菌耐药率整体高于二级医院。结论:河南省患儿血培养分离菌以革兰阳性菌为主,且二三级医院MRSA检出率普遍偏高。患儿血标本肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率呈逐步下降趋势,但仍处于较高水平,且三级医院高于二级医院。Objective:The study aimed to investigate the distribution and antibiotic resistance profile of isolated Bacteria of the blood samples,and provide reasonable rationale for drug utilization for clinical prevention and treatment of bloodstream infections.Methods:WHONET V5.6(software)was applied to analyze the distribution and antibiotic resistance of bacteria isolated from blood cultures of pediatric patients reported by 221 units of Clinical Microbiology Alliance of Henan Province from 2019 to 2021.Results:A total of 10901 bacteria isolates were collected from blood samples of pediatric patients from 2019 to 2021,among which gram-positive bacteria and gram-negative bacteria accounted for 73.1%and 26.9%,respectively.Coagulase-negative staphylococcus ranked the top,and the top five are coagulasenegative staphylococcus,Staphylococcus aureus,Escherichia coli,Streptococcus pneumoniae and Klebsiella pneumoniae.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA)and penecillin resistant Streptococcus pneumonia(PRSP)was 43.0%and 2.3%,respectively.The resistance rates of Escherichia coli to imipenem and meropenem were 2.2%and 2.3%,while 30.4%and 28.9%for Klebsiella pneumoniae.The resistance rates of Enterobacteriaceae strains in the tertiary hospitals was significantly higher than that in the secondary hospitals.Conclusion:The main isolated bacteria from blood culture of pediatric patients in Henan Province are Gram-positive bacteria.The detection rate of MRSA in the secondary and the tertiary hospitals was relatively high.The resistance rate of Klebsiella pneumoniae to carbapenems in blood samples of pediatric patients showed a gradual downward trend,but it was still at a high level with tertiary hospitals was significantly higher than secondary hospitals.

关 键 词：儿童 血流感染 血培养 耐药性 病原菌 

分 类 号：R446.5[医药卫生—诊断学]