CAJ | 학술논문

目的：分析近5年我院PICU细菌病原学谱的特点及其耐药性改变，指导临床合理用药。方法回顾性分析2009年1月1日至2013年12月30日我院PICU所有细菌培养阳性结果，按不同年份进行分类，了解各年份PICU细菌病原学谱及耐药性，总结其变化特点。结果5年中，我院PICU共送检标本14361份，分离出2201株病原菌，培养阳性率15.3％。其中革兰阴性菌63.9％（1406株），革兰阳性菌36.1％（795株）。2009至2013年革兰阴性菌所占比例分别为83.2％、71.0％、59.8％、58.9％、52.5％；革兰阳性菌所占比例分别为16.8％、29.0％、40.2％、41.1％、47.5％。前五位病原菌为：金黄色葡萄球菌（16.6％，366株）、大肠埃希菌（16.2％，357株）、肺炎克雷白杆菌（15.2％，334株）、肺炎链球菌（9.2％，202株）、流感嗜血杆菌（6.8％，149株）。其中，金黄色葡萄球菌感染率逐年上升（6.4％～27.0％）。药敏结果显示超广谱β内酰胺酶阳性大肠埃希菌及肺炎克雷白杆菌比例分别为28.3％、38.3％；耐甲氧西林金黄色葡萄球菌比例为26.0％；肺炎链球菌按照非颅内感染折点判断，对青霉素耐药率为19.3％，多重耐药比例为58.9％。上述各菌株5年内耐药率无明显变化。结论近5年 PICU细菌病原学谱仍以革兰阴性菌为主，但革兰阳性菌感染比例逐年升高，金黄色葡萄球菌已成为近5年我院PICU最常见致病菌之一。5年中，超广谱β内酰胺酶阳性大肠埃希菌及肺炎克雷白杆菌、耐甲氧西林金黄色葡萄球菌、肺炎链球菌耐药率无明显变化。细菌分析及耐药性监测对指导临床危重患儿的抗感染治疗有重要意义。
목적：분석근5년아원PICU세균병원학보적특점급기내약성개변，지도림상합리용약。방법회고성분석2009년1월1일지2013년12월30일아원PICU소유세균배양양성결과，안불동년빈진행분류，료해각년빈PICU세균병원학보급내약성，총결기변화특점。결과5년중，아원PICU공송검표본14361빈，분리출2201주병원균，배양양성솔15.3％。기중혁란음성균63.9％（1406주），혁란양성균36.1％（795주）。2009지2013년혁란음성균소점비례분별위83.2％、71.0％、59.8％、58.9％、52.5％；혁란양성균소점비례분별위16.8％、29.0％、40.2％、41.1％、47.5％。전오위병원균위：금황색포도구균（16.6％，366주）、대장애희균（16.2％，357주）、폐염극뢰백간균（15.2％，334주）、폐염련구균（9.2％，202주）、류감기혈간균（6.8％，149주）。기중，금황색포도구균감염솔축년상승（6.4％～27.0％）。약민결과현시초엄보β내선알매양성대장애희균급폐염극뢰백간균비례분별위28.3％、38.3％；내갑양서림금황색포도구균비례위26.0％；폐염련구균안조비로내감염절점판단，대청매소내약솔위19.3％，다중내약비례위58.9％。상술각균주5년내내약솔무명현변화。결론근5년 PICU세균병원학보잉이혁란음성균위주，단혁란양성균감염비례축년승고，금황색포도구균이성위근5년아원PICU최상견치병균지일。5년중，초엄보β내선알매양성대장애희균급폐염극뢰백간균、내갑양서림금황색포도구균、폐염련구균내약솔무명현변화。세균분석급내약성감측대지도림상위중환인적항감염치료유중요의의。
Objective To analyze the five years change of bacterial infection adn drug resistance in PICU and to provide evidence for use of na tibiotics rationally.Methods Al the pathoeg nic bacteria from patients in PICU of our hospital from January 1 2009 to Deec mber 31 2013 were analyzed retrospectiev ly. T hey were divided into five subgroups according to differetn years.Pathogenic batc eria and drug resistance in different years wre e collected na d the changes of such bacterial infection and drug resistance were compared and summarized.Results A total of 2 201 pathogenic bacterial strains were isolated from 14 361 specimens of five-year patients in PICU.The rate of gram negative bacteria in 2009 to 2013 were 83.2%,71.0%, 59.8%,58.9%, 52.5% respe ctively.The rate of gram positive bacteria in 2009 to 2013 were 16.8%, 29.0%,40.2%, 41.1%, 47.5% respectively.Top five pathogenic bacteria were staphylocco cus aureus (16.6%,366 strains),Escherichia coli (16.2%,357 strains),klebsiella pnue moniae (15.2%,334 strains), streptococ us pneumoniae (9.2%,202 strains),haemophilus influenzae (6.8%,149 strains).The infection rate of staphylococcus aureus increased year by year(6.4% to 27.0%).Drug sensitivity tets indicated that the rate of extended-spectrum beta-lactamases ( ESBL) positive escherichia coli and klebsiella pneumoniae were 28.3%and 38.3%,respectivle y.The rate of methicillin-resistant staphylococcus aureus ( MRSA) was 26.0%.Based on non-meningitis criterion,rate of penicillin resistance streptococcus pneumonia and multiple-drugresistance streptococcus pneumonia was 19.3%and 58.9%,respectively.There were no obvious changes in resistance rate of above-mentioned bacteria during the recent five years.Conclusion In the recent five years,gram negative bacteria is still the prevalent strain in PICU of our hospital,however the rate of gram positive bacteria increases year by year and staphylococcus aureus has become one of the five most common bacteria.The rate of ESBL positive escherichia coli,ESBL positive klebsiella pneumonia and MRSA has no obvious changes.Analysis of pathogenic bacteria and drug-resistance surveillance are of vital importance to guide treatments for critically ill patients and reduce drug-resistant bacterial strains.