摘要
目的调查重症监护病房(ICU)患儿临床感染病原菌的分布及耐药趋势,为临床合理选用抗生素提供依据。方法对2009年1月至2010年12月上海市儿童医院ICU住院患儿1974例,取其送检的痰、血、脑脊液等标本中分离出的病原菌,采用vitek 2 compact全自动微生物检定仪鉴定菌种,K-B纸片扩散法进行药敏试验。结果共分离病原菌657株,以革兰阴性杆菌为主(占69.9%),革兰阳性菌占23.4%,真菌占6.7%。革兰阴性杆菌中铜绿假单胞菌占首位(21.3%);其次为鲍曼不动杆菌(19.2%);大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的比例>70.0%,ESBL阳性菌株对头孢他啶、头孢噻肟均有>80%的耐药率,对头孢吡肟有>40%的耐药率;非发酵菌的多重耐药情况严重,鲍曼不动杆菌对头孢他啶、头孢吡肟、亚胺培南、美洛培南均有>75%的耐药率。革兰阳性菌中金黄色葡萄球菌(5.0%),其中耐甲氧西林金黄色葡萄球菌(MRSA)占29%;真菌中以白色假丝酵母菌为主(6.0%),对氟康唑、酮康唑、两性霉素B均敏感。结论儿童重症监护病房耐药感染分布中,革兰阴性杆菌感染仍占优势。ICU患儿感染病原菌耐药情况较为严重,应加强耐药性监测。
Objective To investigate the tendency of bacterial distribution and drug resistance of pathgens in Pediatric Intensive Care Unit,then instruct clinical application of antibiotics reasonably. Methods The bacteria isolated from patients in PICU from Jan 2009 to Dec 2010 were identified by vitek 2 compact instrument and antibiotic susceptibility was determined by K-B disk diffusion method. Results A total of 657 pathogens strains were isolated,Gram-negative bacilli,Gram-postive cocci and fungi accounted for 69.9%,23.4%,6.7%,respectively. The most common pathogens of them were Pseudomonas aeruginosa （21.3%）,then in series Acinetobacter baumannii （19.2%）; the rate of the ESBL -producing strains of Klebsiella pneumoniae and Escherichia coli was more than 70%,the ceftazidime and cefotaxime resisitant rates of ESBL- positive strains are more than 80%,the cefepime resisitant rate of ESBL-positive strains is more than 40%;the ceftazidime、cefepime、 imipenem、meropenem resisitant rate of Acinetobacter baumannii are more than 75%; Staphylococcus aureus account for 5.0%,29% strains of Staphylococcus aureus were Methicillin resistant S.aureus. The most common strains of fungi were Candida albicans （6.0%）. All of them were sensitive to fluconazole,ketoconazole and amphotericin b. Conclusion The multi-drug resistance of pathogens are serious in PICU. It is important and urgent to carry out surveillance of bacterial resistance for appropriately using antibiotics.
出处
《中国实用儿科杂志》
CSCD
北大核心
2011年第12期920-923,共4页
Chinese Journal of Practical Pediatrics
关键词
儿童重症监护病房
细菌分布
耐药性监测
抗生素
pediatric intensive care unit bacterial distribution surveillance of drug resistance antibiotics
