中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
1期
23-27
,共5页
宋文良%张天鹤%孙莹%柯东月%王丽杰%张智洁%郭锡斌%刘春峰
宋文良%張天鶴%孫瑩%柯東月%王麗傑%張智潔%郭錫斌%劉春峰
송문량%장천학%손형%가동월%왕려걸%장지길%곽석빈%류춘봉
小儿重症监护病房%细菌分布%细菌耐药%抗生素
小兒重癥鑑護病房%細菌分佈%細菌耐藥%抗生素
소인중증감호병방%세균분포%세균내약%항생소
Pediatric intensive care unit%Bacterial distribution%Drug resistance%Antibiotics
目的 调查我院PICU临床感染病原菌的分布及耐药情况,指导临床合理用药.方法 回顾性分析2010年1月至2011年12月我院PICU分离出的病原菌及耐药性.结果 有349例患儿共分离出471株病原菌,标本来源为痰、血、导管、尿及脑脊液等,其中分离革兰阴性杆菌285株(60.5％),革兰阳性球菌168株(35.7％),真菌18株(3.8％).主要病原菌为:鲍曼不动杆菌88株(18.7％)、肺炎克雷白杆菌70株(14.9％)、铜绿假单胞菌51株(10.8％)、肺炎链球菌45株(9.6％)以及大肠埃希菌43株(9.1％).超广谱B内酰胺酶阳性肺炎克雷白杆菌和大肠杆菌的比例分别为65.7％ (46/70)及37.2％(16/43),对绝大多数头孢类抗生素耐药率＞85.0％,非发酵菌的多重耐药情况严重,鲍曼不动杆菌对绝大多数头孢类抗生素耐药率＞70.0％,其中多重耐药菌株78株(88.7％),泛耐药株58株(66.0％).耐甲氧西林金黄色葡萄球菌(7株)及耐甲氧西林凝固酶阴性葡萄球菌(16株)分别占金黄色葡萄球菌及凝固酶阴性葡萄球菌的31.8％和53.3％,对万古霉素全部敏感.结论 PICU中病原菌以革兰阴性杆菌为主,耐药情况较严重,因此加强病原菌分布及耐药性监测十分重要,以指导临床抗感染治疗,防止滥用抗生素.
目的 調查我院PICU臨床感染病原菌的分佈及耐藥情況,指導臨床閤理用藥.方法 迴顧性分析2010年1月至2011年12月我院PICU分離齣的病原菌及耐藥性.結果 有349例患兒共分離齣471株病原菌,標本來源為痰、血、導管、尿及腦脊液等,其中分離革蘭陰性桿菌285株(60.5％),革蘭暘性毬菌168株(35.7％),真菌18株(3.8％).主要病原菌為:鮑曼不動桿菌88株(18.7％)、肺炎剋雷白桿菌70株(14.9％)、銅綠假單胞菌51株(10.8％)、肺炎鏈毬菌45株(9.6％)以及大腸埃希菌43株(9.1％).超廣譜B內酰胺酶暘性肺炎剋雷白桿菌和大腸桿菌的比例分彆為65.7％ (46/70)及37.2％(16/43),對絕大多數頭孢類抗生素耐藥率＞85.0％,非髮酵菌的多重耐藥情況嚴重,鮑曼不動桿菌對絕大多數頭孢類抗生素耐藥率＞70.0％,其中多重耐藥菌株78株(88.7％),汎耐藥株58株(66.0％).耐甲氧西林金黃色葡萄毬菌(7株)及耐甲氧西林凝固酶陰性葡萄毬菌(16株)分彆佔金黃色葡萄毬菌及凝固酶陰性葡萄毬菌的31.8％和53.3％,對萬古黴素全部敏感.結論 PICU中病原菌以革蘭陰性桿菌為主,耐藥情況較嚴重,因此加彊病原菌分佈及耐藥性鑑測十分重要,以指導臨床抗感染治療,防止濫用抗生素.
목적 조사아원PICU림상감염병원균적분포급내약정황,지도림상합리용약.방법 회고성분석2010년1월지2011년12월아원PICU분리출적병원균급내약성.결과 유349례환인공분리출471주병원균,표본래원위담、혈、도관、뇨급뇌척액등,기중분리혁란음성간균285주(60.5％),혁란양성구균168주(35.7％),진균18주(3.8％).주요병원균위:포만불동간균88주(18.7％)、폐염극뢰백간균70주(14.9％)、동록가단포균51주(10.8％)、폐염련구균45주(9.6％)이급대장애희균43주(9.1％).초엄보B내선알매양성폐염극뢰백간균화대장간균적비례분별위65.7％ (46/70)급37.2％(16/43),대절대다수두포류항생소내약솔＞85.0％,비발효균적다중내약정황엄중,포만불동간균대절대다수두포류항생소내약솔＞70.0％,기중다중내약균주78주(88.7％),범내약주58주(66.0％).내갑양서림금황색포도구균(7주)급내갑양서림응고매음성포도구균(16주)분별점금황색포도구균급응고매음성포도구균적31.8％화53.3％,대만고매소전부민감.결론 PICU중병원균이혁란음성간균위주,내약정황교엄중,인차가강병원균분포급내약성감측십분중요,이지도림상항감염치료,방지람용항생소.
Objective To investigate the epidemic distribution and drug resistance of pathogens in PICU in Shengjing Hospital of China Medical University.Methods We retrospectively analyzed the pathogens isolated from patients in PICU from Jan 2010 to Dec 2011.The specimens were from sputum,bloodstream,tube (such as endotracheal tube,deep vein catheterization),urine,cerebrospinal fluid and so on.Results Total of 471 pathogens were isolated from 349 patients,and Gram-negative bacilli,Gram-positive cocci and fungi accounted for 60.5％ (285/471),35.7％ (168/471),3.8％ (18/471) respectively.The top 5 pathogens were the followings:Acinetobacter baumannii 88 strains (18.7％),Klebsiella pneumonia 70 strains (14.9％),Pseudomonas aeruginosa 51 strains (10.8％),Stroptococci pneumonia 45 strains (9.6％) and Escherichia coli 43 strains (9.1％) ;the rate of extended-spectrum beta-lactamase-producing strains of Klebsiella pneumonia and Escherichia coli were 65.7％ (46/70)and 37.2％ (16/43) respectively,and the resistant rates of them to Cephalosporin antibiotics were more than 85.0％.There was severe condition of multidrug resistance for non-fermentation bacteria,especially for Acinetobacter baumannii.The resistant rate of Acinetobacter baumannii to most Cephalosporin antibiotics was more than 70％,including 78 multidrug-resistant strain(88.7％) and 58 pandrug-resistant strain(66.0％).In Gram-positive cocci,31.8％ of staphylococcus aureus and 53.3％ of coagulase negative staphylococci were Methicitlin resistant staphylococcus aureus (7 strains) and Methicillin resistant coagulase negative staphylococci (16 strains),which were 100％ sensitive to Vancomycin.Conclusion Gram-negative bacilli are the main pathogens in PICU,and drug resistance rate is high.Recently the multi-drug resistance is increasing.So it is important to carry out surveillance of pathogens distribution and bacterial resistance.
