摘要
目的探讨2010-2015年医院住院败血症患儿的致病菌与耐药性状况,为临床治疗提供科学依据。方法回顾性分析2010年1月-2015年12月在医院儿科住院治疗的386例败血症患儿的临床资料,统计分析2010-2011年、2012-2013年、2014-2015年病原菌分布和耐药性。结果 2010-2011年162例患儿血培养分离出170株病原菌,其中革兰阳性菌占52.4%,革兰阴性菌占46.5%,真菌占1.2%;2012-2013年121例患儿分离培养出126株病原菌,其中革兰阳性菌占62.7%,革兰阴性菌占36.5%,真菌占0.8%,2014-2015年103例患儿共分离培养出105例病原菌,其中革兰阳性菌占65.7%,革兰阴性菌占33.3%,真菌占1.0%;2010-2011年肺炎链球菌对红霉素耐药率86.2%,对万古霉素耐药率0,2012-2013年,肺炎链球菌对红霉素、克林霉素耐药率分别为96.0%和84.0%,对环丙沙星和万古霉素的耐药率分别8.0%和0,2014-2015年,肺炎链球菌对红霉素、克林霉素的耐药率分别为100.0%和91.7%,对环丙沙星、左氧氟沙星、万古霉素的耐药率分别为8.3%、8.3%和0;2010-2011年、2012-2013年、2014-2015年,表皮葡萄球菌对青霉素的耐药率分别为90.5%、100.0%和100.0%,表皮葡萄球菌对阿莫西林的耐药率分别为85.7%、100.0%和100.0%,耐药性呈逐年上升趋势,表皮葡萄球菌对万古霉素的耐药率均为0%。2010-2011年,2012-2013年,2014-2015年,大肠埃希菌对氨苄西林的耐药性分别为80.0%、93.3%、100.0%,大肠埃希菌对阿米卡星的耐药率分别为8.0%、6.7%和9.1%,大肠埃希菌对亚胺培南、美罗培南的耐药性均为0;2010-2011年、2012-2013年、2014-2015年,沙门属菌对亚胺培南和美罗培南的耐药性均为0,沙门属菌对氨苄西林的耐药性分别为28.6%、76.9%和88.9%。结论医院住院败血症患儿血培养中病原菌以肺炎链球菌、大肠埃希菌和表皮葡萄球菌为主,且病原菌的耐药性均呈逐年上升趋势,青霉素、红霉素不能再作为治疗革兰阳性菌的常规治疗选择,氨苄西林对革兰阴性菌的耐药性较高,均需要引起足够重视,并针对检出的病原菌选择合适抗菌药物,提升住院败血症患儿的治疗效果。
OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from children with septicemia who were hospitalized from 2010 to 2015 so as to provide scientific basis for clinical treatment.METHODS A total of 386 children with septicemia who were hospitalized in the department of pediatrics from Jan 2010 to Dec 2015 were enrolled in the study, the clinical data of the study objects were retrospectively analyzed.The distribution and drug resistance of the pathogens that were isolated from 2010 to 2011, from 2012 to 2013, and from 2014 to 2015 were statistically analyzed.RESULTS Totally 170 strains of pathogens were isolated from blood specimens of 162 children in 2010-2011, of which 52.4% were gram-positive bacteria, 46.5% were gram-negative bacteria, and 1.2% were fungi.Totally 126 strains of pathogens were isolated from 121 children in 2012-2013, of which 62.7% were gram-positive bacteria, 36.5% were gram-negative bacteria, and 0.8% were fungi.Totally 105 strains of pathogens were isolated from 103 children in 2014-2015, of which 65.7% were gram-positive bacteria, 33.3% were gram-negative bacteria, and 1.0% were fungi.In 2010-2011, the drug resistance rate of Streptococcus pneumoniae strains to erythromycin was 86.2%, the drug resistance rate to vancomycin 0;the drug resistance rates of S.pneumoniae strains to erythromycin and clindamycin were respectively 96.0% and 84.0% in 2012-2013, and the drug resistance rates to ciprofloxacin and vancomycin were respectively 8.0% and 0;the drug resistance rates of S.pneumoniae strains to erythromycin and clindamycin were respectively 100.0% and 91.7% in 2014-2015, the drug resistance rates to ciprofloxacin, levofloxacin, and vancomycin were respectively 8.3%, 8.3%, and 0.The drug resistance rate of Staphylococcus epidermidis strains to penicillin was 90.5% in 2010-2011, 100.0% in 2012-2013, 100.0% in 2014-2015;the drug resistance rate of S.epidermidis strains to amoxicillin was 85.7% in 2010-2011, 100.0% in 2012-2013, 100.0% in 2014-2015, and the drug resistance rate showed an upward trend;the drug resistance rate of S.epidermidis strains to vancomycin was 0%.The drug resistance rate of Escherichia coli strains to ampicillin was 80.0% in 2010-2011, 93.3% in 2012-2013, 100.0% in 2014-2015;the drug resistance rate of E.coli strains to amikacin was 8.0% in 2010-2011, 6.7% in 2012-2013, 9.1% in 2014-2015;the drug resistance rates of E.coli strains to imipenem and meropenem were 0.The drug resistance rates of Salmonella to imipenem and meropenem were 0 in 2010-2011, 2012-2013, and 2014-2015;the drug resistance rate of Salmonella to ampicillin was 28.6% in 2010-2011, 76.9% in 2012-2013, 88.9% in 2014-2015.CONCLUSION S.pneumoniae, E.coli and S.epidermidis are predominant species of pathogens isolated from blood specimens of the hospitalized children with septicemia, and the drug resistance rates of the pathogens show upward trend.Penicillin and erythromycin can no longer be used for conventional treatment of gram-positive bacteria infection, the gram-negative bacteria are highly resistant to ampicillin, which should be attached great importance to.It is necessary to choose appropriate antibiotics according to the isolated pathogens so as to raise the therapeutic effect of the hospitalized children with septicemia.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第16期3791-3794,共4页
Chinese Journal of Nosocomiology
关键词
败血症
患儿
致病菌
耐药性
Septicemia
Child
Pathogen
Drug resistance
