CAJ | 학술논문

目的：了解脓毒血症患儿细菌病原菌构成及耐药状况的变迁。方法回顾性分析2002年至2011年连续10年监测的脓毒血症患儿血培养阳性病原菌的构成比及耐药性。结果2002-2011年68419份血培养标本中检出2493株病原菌，检出率3.64%。革兰阳性菌株（G+菌）1913株（76.73%），革兰阴性杆菌（G-菌）562株（22.54%），真菌18株（0.72%）。2002-2006年20287例患儿中血培养阳性959例（4.73%），G+菌731株（76.23%），G-菌228株（23.77%）；2007-2011年48132例患儿中血培养阳性1534例（3.19%），G+菌1182株（77.05%），G-菌334株（21.77%），真菌18株（1.17%）。前后5年的血培养阳性率，G +菌、G-菌和真菌的检出分布的差异均有统计学意义（P<0.01），G+菌检出率有增高趋势，G-菌检出率有下降趋势。前后5年以及不同年龄组脓毒症患儿的病原菌分布差异均有统计学意义（P<0.01），以凝固酶阴性葡萄球菌为主；前后5年比较，凝固酶阴性葡萄球菌、克雷伯氏菌、产碱杆菌、真菌的阳性率有增高趋势，而金黄色葡萄球菌、肠球菌、假单孢菌属、沙门氏菌阳性率有降低趋势。10年间G+菌对青霉素、红霉素呈现高度耐药，未发现万古霉素耐药菌株；大肠埃希菌ESBLs阳性菌株、克雷伯菌ESBLs阳性及阴性菌株对抗生素均呈现高度耐药；沙门菌对常用抗生素敏感性较高。结论10年间儿童脓毒血症主要病原菌以凝固酶阴性葡萄球菌为主，病原菌对常用抗生素耐药率呈逐年增高趋势。
목적：료해농독혈증환인세균병원균구성급내약상황적변천。방법회고성분석2002년지2011년련속10년감측적농독혈증환인혈배양양성병원균적구성비급내약성。결과2002-2011년68419빈혈배양표본중검출2493주병원균，검출솔3.64%。혁란양성균주（G+균）1913주（76.73%），혁란음성간균（G-균）562주（22.54%），진균18주（0.72%）。2002-2006년20287례환인중혈배양양성959례（4.73%），G+균731주（76.23%），G-균228주（23.77%）；2007-2011년48132례환인중혈배양양성1534례（3.19%），G+균1182주（77.05%），G-균334주（21.77%），진균18주（1.17%）。전후5년적혈배양양성솔，G +균、G-균화진균적검출분포적차이균유통계학의의（P<0.01），G+균검출솔유증고추세，G-균검출솔유하강추세。전후5년이급불동년령조농독증환인적병원균분포차이균유통계학의의（P<0.01），이응고매음성포도구균위주；전후5년비교，응고매음성포도구균、극뢰백씨균、산감간균、진균적양성솔유증고추세，이금황색포도구균、장구균、가단포균속、사문씨균양성솔유강저추세。10년간G+균대청매소、홍매소정현고도내약，미발현만고매소내약균주；대장애희균ESBLs양성균주、극뢰백균ESBLs양성급음성균주대항생소균정현고도내약；사문균대상용항생소민감성교고。결론10년간인동농독혈증주요병원균이응고매음성포도구균위주，병원균대상용항생소내약솔정축년증고추세。
Objective To determine the pathogenic bacteria distribution and drug resistance in children with sepsis. Methods From 2002 to 2011, a ten consecutive years of monitoring of pathogenic bacteria distribution, drug resistance in pediatric patients with sepsis were conducted. Results From 2002 to 2011, 2 493 strains of pathogenic bacteria were detected in 68 419 specimens of blood culture. The positive rate was 3.64%. Among them, 1 913 strains (76.73%) were the gram-positive bacteria (G+bacteria), 562 strains (22.54%) were gram-negative bacteria (G-bacteria) and 18 strains (0.72%) were fungi. From 2002 to 2006, 959 strains (4.73%) of pathogenic bacteria were detected in 20 287 specimens of blood culture. Among them, the G+bacteria was 731 strains (76.23%), G-bacteria was 228 strains (23.77%). From 2007 to 2011, 1 534 strains (4.73%) of pathogenic bacteria were detected in 48 132 specimens of blood culture, G+ bacteria was 1 182 strains (77.05%), G-bacteria was 334 strains (21.77%), fungi was 18 strains (1.17%). The positive rate of blood culture, the pathogenic bacteria distributions of G+, G-, and fungi were signiifcantly different between the ifrst and the second 5 years (P<0.01). The positive rate of G+bacteria tended to increase and the positive rate of G-bacteria tended to decrease. Com-paring between the ifrst and second 5 years, the positive rate of coagulase-negative staphylococci, Klebsiella, Alcaligenes, fungi tended to increas, and the positive rate of Staphylococcus aureus, Enterococcus, Pseudomonas, Salmonella tended to decrease. The distribution of pathogens in different age groups of children with sepsis also were signiifcantly difference (P<0.001). Over the 10 years, G+positive bacteria were highly resistant to penicillin and erythromycin, but not resistant to Vancomycin. ESBLs positive E. coli strains and Klebsiella Trevisan became highly resistant to antibiotics. Salmonella was sensitive to commonly used antibiotics. Conclusions Coagulase negative staphylococcus was the most common pathogenic bacteria in children with sepsis in the last 10 years, multiple pathogenic bacteria also show a growing trend in drug resis-tance.