摘要
目的 探讨浙江省部分地区近 10年小儿败血症病原菌的变迁及近年常见致病菌的耐药性。方法 对 1991～ 2 0 0 0年浙江省儿童医院住院患儿送检的血标本 ,分别采用肉汤 (1991～ 1996年 )及VITALAER全自动血培养仪 (1997～ 2 0 0 0年 )进行培养 ,采用API系统及VITEK全自动微生物鉴定仪进行菌株鉴定及药敏试验 ,按美国NCCLS标准判断结果。结果 革兰阳性菌检出构成比明显高于革兰阴性菌 ,凝固酶阴性葡萄球菌 (CNS) 10年间逐年增加 ,到 2 0 0 0年检出构成比达 6 9 0 % ,金黄色葡萄球菌及大肠埃希菌逐年下降 ,分别从 1991年 35 4 %、18 2 %下降到 2 0 0 0年 5 3%、1 5 %。葡萄球菌对青霉素的耐药率达 90 %以上 ,对红霉素的耐药率 70 %以上 ;耐苯唑西林CNS达 6 0 2 % ,明显高于金黄色葡萄球菌 10 3% ;未发现耐万古霉素的葡萄球菌和肠球菌。大肠埃希菌、假单胞菌及其他肠杆菌对亚胺培南 西司他丁均敏感 ,而对氨苄西林、第 1代头孢菌素的耐药率多在 5 0 %以上。结论 (1)儿科败血症病原以革兰阳性菌占优势 ,葡萄球菌居首位 ,新生儿和婴儿以CNS为主 ,学龄儿童以金黄色葡萄球菌为主 ;(2 )革兰阴性菌中 ,新生儿和婴儿以大肠埃希菌为主 ,学龄儿童以沙门菌为主 ;(3)儿科检出菌存在严重耐药问题 。
Objective To investigate the changes of pathogenic bacteria detected from the blood culture of pediatric patients with septicemia in the past 10 years, and to observe the drug resistance thereof in the past two years. Methods The blood samples of 4 425 pediatric patients aged 0～14 with the diagnosis of septicemia 1991～2000 in Zhejiang Children′s Hospital were cultured in broth (1991～1996) or VITA AER blood culture apparatus (1997～2000). Analytic Product Inc. (API) system and KB paper strip method and VITEK automicroscan were used to identify the species and conduct drug resistance test. The results were interpreted according to the guideline of National Committee for Clinical Laboratory Standards. Results In the past 10 years, Gram positive bacteria remained the more frequent pathogens than Gram nagetive bacteria in prediatric patients with septicemia. The proportion of coagulase negative staphylococcus (CNS) had been increasing and reached 69% in 2000. The proportions of Staphylococcus aureus and Escherichia coli decreased from 35.4% and 18.2% in 1991 to 5.3% and 1.5% in 2000. In the past twe years, the drug resistance rate of staphylococci against penicillin and erythromycin were more than 90% and 70% respectively. The oxacillin resistance rate of CNS was 60.3%, significantly higher than that of Staphylococcus aureus (10.3%). No strain of Staphylococcus and Enterococcus resistant to vancomycin was found. Escherichia coli and Psudomonas aeruginosa and other species of Enterobacteriae were sensitive to imipenem/cilastin sodium, whereas the resistance rate of them to ampicillin and first generation cephalosporins was more than 50%. Conclusion (1) Gram positive bacteria are the predominant pathogens of pediatric patients with septicemia, with the species of Staphylococcus ranking first among which CNS is the main pathogen for infants and Staphylococcus aureus is the main pathogen for school children. (2) Escherichia coli is the most frequently found pathogenic Gram negative bacterium in infants with septicemia whereas Salmonella in school children. (3) Drug resistance of isolated pathogenic bacteria in department of pediatrics is a serious problem. Monitoring the change of pathogen and the trends of antimicrobial resistance is very important in guiding therapy.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2002年第14期945-948,共4页
National Medical Journal of China
