铜绿假单胞菌%儿科重症监护病房%抗药性,细菌
銅綠假單胞菌%兒科重癥鑑護病房%抗藥性,細菌
동록가단포균%인과중증감호병방%항약성,세균
Pseudomonas aeruginosa%Pediatric intensive care unit%Drug resistance,multiple,becterial
目的 分析我院儿科重症监护病房( PICU)分离出的铜绿假单胞菌(pseudomonas aenginosa,PA)的药敏情况,为临床的合理、有效治疗提供依据. 方法 分析2007年1月1日至2011年12月31 日,我院PICU铜绿假单胞菌培养阳性患儿的年龄分布,转归,菌株来源,药敏分析.总结2010至2011年,我院病原菌分布情况.采用纸片扩散法(K-B法)和微量肉汤稀释法进行体外药敏试验.结果 75例培养阳性.＜6个月26例(34.7％),2岁以下共49例( 65.4％).不同年龄组铜绿假单胞菌培养阳性性患儿占同期患儿总数百分比基本相同.死亡18例(24.0％).2010至201 1年,分离出的铜绿假单胞菌占C-菌10.9％,占细菌总数6.5％.126株PA 83株(65.9％)来自痰培养,31株(24.6％)来自气管插管导管培养,10株(7.9％)来自血培养,2株(1.6％)来自分泌物培养.对儿科临床常用治疗PA的抗生素敏感性:头孢哌酮/舒巴坦(72.4％),美罗培南(71.5％),亚胺培南(48.4％),头孢他啶(66.7％),哌拉西林/他唑巴坦(49.2％).对氨苄西林、头孢唑啉、头孢呋辛及头孢噻肟百分之百耐药.多重耐药依然严重,动态观察有下降趋势,2007年为90.5％,2008年为81.3％,2009年为51.1％,2010年为53.8％,2011年为33.3％.不同年度泛耐药情况变化不大,2008年为12.5％,2009年为2.2％,2010年为7.7％,2011年为6.7％.结论 铜绿假单胞菌耐药形势依然严峻,临床要防止滥用抗生素,以免加重耐药性产生.不断提高实验室检验技术,对PA感染要根据当地的用药经验及药敏结果合理应用敏感抗生素,必要时联合用药,提高治愈率.医护人员要注意手卫生,严格无菌揲作,防止医源性交叉感染.
目的 分析我院兒科重癥鑑護病房( PICU)分離齣的銅綠假單胞菌(pseudomonas aenginosa,PA)的藥敏情況,為臨床的閤理、有效治療提供依據. 方法 分析2007年1月1日至2011年12月31 日,我院PICU銅綠假單胞菌培養暘性患兒的年齡分佈,轉歸,菌株來源,藥敏分析.總結2010至2011年,我院病原菌分佈情況.採用紙片擴散法(K-B法)和微量肉湯稀釋法進行體外藥敏試驗.結果 75例培養暘性.＜6箇月26例(34.7％),2歲以下共49例( 65.4％).不同年齡組銅綠假單胞菌培養暘性性患兒佔同期患兒總數百分比基本相同.死亡18例(24.0％).2010至201 1年,分離齣的銅綠假單胞菌佔C-菌10.9％,佔細菌總數6.5％.126株PA 83株(65.9％)來自痰培養,31株(24.6％)來自氣管插管導管培養,10株(7.9％)來自血培養,2株(1.6％)來自分泌物培養.對兒科臨床常用治療PA的抗生素敏感性:頭孢哌酮/舒巴坦(72.4％),美囉培南(71.5％),亞胺培南(48.4％),頭孢他啶(66.7％),哌拉西林/他唑巴坦(49.2％).對氨芐西林、頭孢唑啉、頭孢呋辛及頭孢噻肟百分之百耐藥.多重耐藥依然嚴重,動態觀察有下降趨勢,2007年為90.5％,2008年為81.3％,2009年為51.1％,2010年為53.8％,2011年為33.3％.不同年度汎耐藥情況變化不大,2008年為12.5％,2009年為2.2％,2010年為7.7％,2011年為6.7％.結論 銅綠假單胞菌耐藥形勢依然嚴峻,臨床要防止濫用抗生素,以免加重耐藥性產生.不斷提高實驗室檢驗技術,對PA感染要根據噹地的用藥經驗及藥敏結果閤理應用敏感抗生素,必要時聯閤用藥,提高治愈率.醫護人員要註意手衛生,嚴格無菌揲作,防止醫源性交扠感染.
목적 분석아원인과중증감호병방( PICU)분리출적동록가단포균(pseudomonas aenginosa,PA)적약민정황,위림상적합리、유효치료제공의거. 방법 분석2007년1월1일지2011년12월31 일,아원PICU동록가단포균배양양성환인적년령분포,전귀,균주래원,약민분석.총결2010지2011년,아원병원균분포정황.채용지편확산법(K-B법)화미량육탕희석법진행체외약민시험.결과 75례배양양성.＜6개월26례(34.7％),2세이하공49례( 65.4％).불동년령조동록가단포균배양양성성환인점동기환인총수백분비기본상동.사망18례(24.0％).2010지201 1년,분리출적동록가단포균점C-균10.9％,점세균총수6.5％.126주PA 83주(65.9％)래자담배양,31주(24.6％)래자기관삽관도관배양,10주(7.9％)래자혈배양,2주(1.6％)래자분비물배양.대인과림상상용치료PA적항생소민감성:두포고동/서파탄(72.4％),미라배남(71.5％),아알배남(48.4％),두포타정(66.7％),고랍서림/타서파탄(49.2％).대안변서림、두포서람、두포부신급두포새우백분지백내약.다중내약의연엄중,동태관찰유하강추세,2007년위90.5％,2008년위81.3％,2009년위51.1％,2010년위53.8％,2011년위33.3％.불동년도범내약정황변화불대,2008년위12.5％,2009년위2.2％,2010년위7.7％,2011년위6.7％.결론 동록가단포균내약형세의연엄준,림상요방지람용항생소,이면가중내약성산생.불단제고실험실검험기술,대PA감염요근거당지적용약경험급약민결과합리응용민감항생소,필요시연합용약,제고치유솔.의호인원요주의수위생,엄격무균설작,방지의원성교차감염.
Objective Pseudomonas aeruginosa is an important cause of nosocomial infection,severe sepsis and death which associated with a trends of rising rates of resistance to a broad array of antimicrobial agents.To explore a feasible treatment protocol for such patients,we analvzed the susceptibility patterns of Pseudomonas aeruginosa in pediatric intensive care unit (PICU). Method The age distribution,outcome of patients,sources of strains and susceptibility patterns of Pseudomonas aeruginosa in PICU from Jan 1,2007 to Dec 31,2011 were analyzed.Susceptibility to amikacin,piperacillin/tazobactam,aztreonam, ampicillin, ciprofloxacin, imipenem, meropenem, cefepime, cefoperazone, cefotaxime,ceftriaxone,ceftazidime,cefoperazone/sulbactam,cephazolin,cefuroxime,and polymyxin were determined by the disk-diffusion technique (K-B test method) and broth microdilution.P.aeruginosa ATCC 27853 was used as reference strain.Result Seventy-five patients were Pseudomonas aeruginosa positive.26(34.7％ ) were ＜ 6 m,49 ( 65.4％ ) were ＜ 2 y.The percentages of cases who were Pseudomonas aerugiosa positive in different age groups in the same time was basically similar; 18 (24.0％) cases died. Pseudomonas aeruginosa accounted for 10.9％ of G- germs s,6.5％ of all pathogens in 2010-2011.Of the 126 strains,83(65.9％) were from sputum sample,31 (24.6％ ) were from catheter sample of tracheal eannula, 10 (7.9％) were from blood sample and 2( 1.6％ )were from secretion sample.The sensitivity to antibiotics of Pseudomonas aeruginosa in pediatric common treatments was 72.4％ to cefoperazone/sulbaetam,71.5％ to meropenem,48.4％ to imipenem,66.7％ to ceftazidime,49.2％ to piperacillin/tazobactam1. Absolute resistance to ampicillin,cephazolin,cefuroxime and cefotaxime. Multiple-drug resistance was still severe,but a decreasing tendency was observed,90.5％ in 2007,81.3％ in 2008,51.1％ in 2009,53.8％ in2010,33.3％ in 2011.Pan-drug resistance in different years was similar,12.5％ in 2008,2.2％ in 2009,7.7％ in 2010,6.7％ in 2011. Conclusion The condition of drug resistance of Pseudomonas aeruginosa was still rigorous, we should conduct surveillance and prevent abusing antibiotics in order to avoid exacerbating drug resistance. We should improve testiug technique, early and appropriate empirical antibiotics therapy is crucial according to clinical experience and antibiotic sensitivity. The effective treatmeut of P.aeruginosa is paramount to prevent multidrug resistance.The use of combination therapies for P. aeruginosa infection has been a long-advocated practice. To prevent hospital acquired cross infection,health care workers must pay close attention to hand sanitation and sterile operation strictly.
