CAJ | 학술논문

目的：了解儿童医院血培养病原菌的构成及耐药性变迁，为儿科血流感染性疾病的治疗提供依据。方法将某院2009年1月-2013年12月住院患儿血培养分离病原菌按时间分成2009-2011年组和2012-2013年组，对病原菌构成及其药物敏感性进行分析。结果共采集48455例患儿血培养标本，分离病原菌2730株，阳性率5．63％。2009-2013年患儿血培养阳性率呈逐年下降趋势（χ2＝415．30，P ＜0．01）。2730株病原菌中，革兰阳性（G＋）菌2194株（80．37％），革兰阴性（G-）菌510株（18．68％），真菌26株（0．95％）。两组病原菌构成比较，差异具有统计学意义（χ2＝180．334，P ＜0．001）。万古霉素、利奈唑胺和替考拉宁对主要 G＋球菌始终保持高敏感性（敏感率达100％），环丙沙星、复方磺胺甲口恶唑和四环素对凝固酶阴性葡萄球菌和金黄色葡萄球菌的耐药性均有下降。亚胺培南、美罗培南和阿米卡星对主要 G-杆菌均保持较高的敏感性（敏感率≥97．50％），左氧氟沙星对于肺炎克雷伯菌保持较高敏感性（敏感率达100％）；头孢菌素中，除头孢他啶对大肠埃希菌，头孢吡肟对肺炎克雷伯菌敏感外，其他均保持较高的耐药率。结论2009-2013年儿童血培养病原菌构成发生明显变迁，病原菌对临床常用抗菌药物有较高的耐药性，临床应加强对血培养病原菌及其耐药性的监测。
목적：료해인동의원혈배양병원균적구성급내약성변천，위인과혈류감염성질병적치료제공의거。방법장모원2009년1월-2013년12월주원환인혈배양분리병원균안시간분성2009-2011년조화2012-2013년조，대병원균구성급기약물민감성진행분석。결과공채집48455례환인혈배양표본，분리병원균2730주，양성솔5．63％。2009-2013년환인혈배양양성솔정축년하강추세（χ2＝415．30，P ＜0．01）。2730주병원균중，혁란양성（G＋）균2194주（80．37％），혁란음성（G-）균510주（18．68％），진균26주（0．95％）。량조병원균구성비교，차이구유통계학의의（χ2＝180．334，P ＜0．001）。만고매소、리내서알화체고랍저대주요 G＋구균시종보지고민감성（민감솔체100％），배병사성、복방광알갑구악서화사배소대응고매음성포도구균화금황색포도구균적내약성균유하강。아알배남、미라배남화아미잡성대주요 G-간균균보지교고적민감성（민감솔≥97．50％），좌양불사성대우폐염극뢰백균보지교고민감성（민감솔체100％）；두포균소중，제두포타정대대장애희균，두포필우대폐염극뢰백균민감외，기타균보지교고적내약솔。결론2009-2013년인동혈배양병원균구성발생명현변천，병원균대림상상용항균약물유교고적내약성，림상응가강대혈배양병원균급기내약성적감측。
Objective To investigate the change in distribution and antimicrobial resistance of pathogens from blood culture of children,and provide a basis for treatment of bloodstream infection.Methods Pathogens isolated from blood culture of hospitalized children between January 2009 and December 2013 were divided into group 2009-2011 and 2012-2013.Distribution and antimicrobial susceptibility of pathogens were analyzed.Results From 2009 to 2013,a total of 48 455 blood specimens were taken for culture,2 730 pathogenic bacteria were isolated,positive rate was 5.63%.The positive rate of blood culture decreased year-by-year (χ2 =415.30,P <0.01 ).Of 2 730 iso-lates of pathogenic bacteria,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 80.37% (n =2 194),18.68%(n=510),and 0.95%(n=26)respectively.The difference between two groups of pathogenic bacte-ria was significant(χ2 =180.334,P <0.001).Susceptibility rates of gram-positive cocci to vancomycin,linezolid and teicoplanin were all 100%,resistance rates of coagulase-negative Staphylococcus and Staphylococcus aureus to cip-rofloxacin,compound sulfamethoxazole and tetracycline all decreased.Susceptibility rates of gram-negative bacilli to imipenem,meropenem and amikacin were all≥97.50%,susceptibility rate of Klebsiella pneumoniae to levofloxacin was 100%;Of cephalosporins,Escherichia coli and Klebsiella pneumoniae had high resistance except ceftazidime and cefepime.Conclusion Distribution of pathogens from blood culture of children in 2009-2013 changed signifi-cantly,pathogens have high resistance to commonly used antimicrobial agents,more attention should be paid to the monitor of pathogens from blood culture and pathogenic antimicrobial resistance.