摘要
目的 了解郑州大学附属儿童医院从腹水中分离病原菌的分布特点及耐药情况,为临床合理使用抗菌药物提供依据。方法 对2015年1月至2021年12月送检的1 058份非重复腹水标本进行细菌培养、鉴定及药敏分析。使用WHONET 5.6及SAS9.4进行统计分析。结果 586(55.39%)例阳性标本分离出病原菌781株,不同年份阳性检出率无升高或降低趋势。男性患儿(63.99%)多于女性患儿。阑尾炎(59.22%)是腹腔感染最常见的疾病;检出最多的细菌是大肠埃希菌。新生儿(≤28 d)中,检出率最高的细菌是肺炎克雷伯(23.50%)和屎肠球菌(23.50%),儿童(>28 d)检出率最高的细菌是大肠埃希菌(35.98%)。781株菌中,革兰阴性细菌占64.79%,主要是大肠埃希菌(38.28%)、肺炎克雷伯菌(8.58%)、铜绿假单胞菌(5.89%)等。革兰阳性菌占29.45%,主要是屎肠球菌(8.58%)、星座链球菌(2.69%)和鸟肠球菌(2.43%)等。真菌占1.66%,厌氧菌占4.10%。大肠埃希菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南和美罗培南的耐药率分别为6.02%、4.35%、4.35%、和3.68%。肺炎克雷伯菌对这些药物的耐药率分别为59.70%、59.70%、50.75%和53.73%。屎肠球菌对利奈唑胺出现耐药菌株。结论 儿童腹腔感染以阑尾炎最常见,腹水病原菌在不同年龄和疾病中的分布有差异。病原菌以革兰阴性菌为主,肺炎克雷伯的耐药情况较为严重。临床应正确合理使用抗菌药物,减少耐药菌的产生。
Objective To investigate the distribution and drug resistance of pathogenic bacteria separated from ascites of patients in Children’s Hospital Affiliated to Zhengzhou University from 2015 to 2021,and to provide a basis for rational clinical antimicrobial agents.Methods Bacterial culture,bacterial identification and drug sensitivity analysis were performed on 1058 non-duplicate ascites culture specimens from January 2015 to December 2021.The clinica1 and microbiologica1 data were ana1yzed by WHONET 5.6 and SAS 9.4 Results Of the 1058 specimens,586(55.39%)were positive for pathogenic bacteria,with a total of 781 strains isolated.There was no significant trend of increase or decrease in the positivity rate over different years.Male children(63.99%)were more prevalent than female children.Appendicitis(59.22%)was the most common disease and Escherichia coli was the most common causative bacteria.Among neonates(≤28 d),the bacteria with the highest detection rate were Klebsiella pneumoniae(23.50%)and Enterococcus faecium(23.50%),while among children(>28 d),the highest detection rate was Escherichia coli(35.98%).Gram-negative bacteria accounted for 64.79%of the 781 strains,mainly Escherichia coli(38.28%),Klebsiella pneumoniae(8.58%),and Pseudomonas aeruginosa(5.89%);Gram-positive bacteria accounted for 29.45%,mainly Enterococcus faecium(8.58%),Streptococcus constellatus(2.69%),and Enterococcus avium(2.43%);fungi accounted for 1.66%and anaerobic bacteria accounted for 4.10%.The resistance rates of Escherichia coli to cefoperazone/sulbactam,piperacillin/tazobactam,imipenem and meropenem were 6.02%,4.35%,4.35%,and 3.68%,respectively.The resistance rates of Klebsiella pneumoniae to these drugs were 59.70%,59.70%,50.75%and 53.73%respectively.Linezolid-resistant strains of Enterococcus faecium were found.Conclusion Appendicitis is the most common abdominal infection in children,and the distribution of ascites pathogens varies with ages and diseases.The pathogenic bacteria are mainly Gram-negative bacteria,and the drug resistance of Klebsiella pneumoniae was more serious.It is particularly important to use antibiotics correctly and rationally to reduce the emergence of drug resistant bacteria.
作者
甄明慧
周莹
周娟娟
高凯杰
杨俊文
ZHEN Ming-hui;ZHOU Ying;ZHOU Juan-juan;GAO Kai-jie;YANG Jun-wen(Affiliated to Zhengzhou University,Zhengzhou,Henan 450018,China)
出处
《中国热带医学》
CAS
2023年第5期516-522,共7页
China Tropical Medicine
基金
2021年度河南省重点研发与推广专项(No.212102310730)。
关键词
儿童
腹水
病原菌
分布
耐药性
Children
ascites
pathogenic bacteria
distribution
drug resistance
