2010-2015年败血症患儿病原菌与耐药性分析

发布时间：2018-11-09 07:38

【摘要】：目的探讨2010-2015年医院住院败血症患儿的致病菌与耐药性状况,为临床治疗提供科学依据。方法回顾性分析2010年1月-2015年12月在医院儿科住院治疗的386例败血症患儿的临床资料,统计分析2010-2011年、2012-2013年、2014-2015年病原菌分布和耐药性。结果 2010-2011年162例患儿血培养分离出170株病原菌,其中革兰阳性菌占52.4%,革兰阴性菌占46.5%,真菌占1.2%;2012-2013年121例患儿分离培养出126株病原菌,其中革兰阳性菌占62.7%,革兰阴性菌占36.5%,真菌占0.8%,2014-2015年103例患儿共分离培养出105例病原菌,其中革兰阳性菌占65.7%,革兰阴性菌占33.3%,真菌占1.0%;2010-2011年肺炎链球菌对红霉素耐药率86.2%,对万古霉素耐药率0,2012-2013年,肺炎链球菌对红霉素、克林霉素耐药率分别为96.0%和84.0%,对环丙沙星和万古霉素的耐药率分别8.0%和0,2014-2015年,肺炎链球菌对红霉素、克林霉素的耐药率分别为100.0%和91.7%,对环丙沙星、左氧氟沙星、万古霉素的耐药率分别为8.3%、8.3%和0;2010-2011年、2012-2013年、2014-2015年,表皮葡萄球菌对青霉素的耐药率分别为90.5%、100.0%和100.0%,表皮葡萄球菌对阿莫西林的耐药率分别为85.7%、100.0%和100.0%,耐药性呈逐年上升趋势,表皮葡萄球菌对万古霉素的耐药率均为0%。2010-2011年,2012-2013年,2014-2015年,大肠埃希菌对氨苄西林的耐药性分别为80.0%、93.3%、100.0%,大肠埃希菌对阿米卡星的耐药率分别为8.0%、6.7%和9.1%,大肠埃希菌对亚胺培南、美罗培南的耐药性均为0;2010-2011年、2012-2013年、2014-2015年,沙门属菌对亚胺培南和美罗培南的耐药性均为0,沙门属菌对氨苄西林的耐药性分别为28.6%、76.9%和88.9%。结论医院住院败血症患儿血培养中病原菌以肺炎链球菌、大肠埃希菌和表皮葡萄球菌为主,且病原菌的耐药性均呈逐年上升趋势,青霉素、红霉素不能再作为治疗革兰阳性菌的常规治疗选择,氨苄西林对革兰阴性菌的耐药性较高,均需要引起足够重视,并针对检出的病原菌选择合适抗菌药物,提升住院败血症患儿的治疗效果。
[Abstract]:Objective to investigate the pathogenic bacteria and drug resistance of hospitalized septicemia children from 2010 to 2015, and to provide scientific basis for clinical treatment. Methods the clinical data of 386 children with septicemia who were hospitalized in pediatrics from January 2010 to December 2015 were analyzed retrospectively. The distribution and drug resistance of pathogens in 2010-2011, 2012-2013 and 2014-2015 were statistically analyzed. Results 170 strains of pathogenic bacteria were isolated from blood culture of 162 children in 2010-2011. Gram-positive bacteria accounted for 52.4%, Gram-negative bacteria accounted for 46.5%, fungi accounted for 1.2%. 126 strains of pathogenic bacteria were isolated from 121 children in 2012-2013, of which 62.7 were Gram-positive, 36.5 were Gram-negative, and 0.8103 were fungi. 105 pathogens were isolated from 103 children in 2014-2015. Gram-positive bacteria accounted for 65.7%, Gram-negative bacteria accounted for 33.3%, fungi accounted for 1.0%; In 2010-2011, the resistance rate of Streptococcus pneumoniae to erythromycin was 86.2%, and vancomycin resistance rate was 0%. In 2012-2013, the resistance rates of Streptococcus pneumoniae to erythromycin and clindamycin were 96.0% and 84.0%, respectively. The resistance rates of Streptococcus pneumoniae to erythromycin and clindamycin were 100.0% and 91.7%, respectively, to ciprofloxacin and vancomycin in 2014-2015, and to ciprofloxacin and levofloxacin, the resistance rates of Streptococcus pneumoniae to erythromycin and clindamycin were 100.0% and 91.7%, respectively. The resistance rate of vancomycin was 8.3% and 0%, respectively. In 2010-2011, 2012-2013, 2014-2015, the resistance rate of Staphylococcus epidermidis to penicillin was 90.5% and 100.0%, respectively, and the resistance rate of Staphylococcus epidermidis to amoxicillin was 85.7%. The resistance of Staphylococcus epidermidis to vancomycin increased year by year, and the resistance rates of Staphylococcus epidermidis to vancomycin were both 0.2010-2011, 2012-2013, 2014-2015, respectively. The resistance of Escherichia coli to ampicillin was 80. 0% and 93. 33%, respectively. The resistance rates of Escherichia coli to amikacin were 8. 7% and 9. 1%, respectively. The resistance rates of Escherichia coli to imipenem were 8. 7% and 9. 1%, respectively, and those of Escherichia coli to imipenem were 8. 0% and 9. 1%, respectively. The drug resistance of meropenem was 0; In 2010-2011, 2012-2013, 2014-2015, the resistance of Salmonella to imipenem and meropenem was 0, and the resistance of Salmonella to ampicillin was 28.676. 9% and 88. 9%, respectively. Conclusion Streptococcus pneumoniae, Escherichia coli and Staphylococcus epidermidis are the main pathogens in blood culture of children with septicemia in hospital. Erythromycin can no longer be used as a routine treatment option for gram-positive bacteria. Ampicillin is highly resistant to gram-negative bacteria, which requires sufficient attention and appropriate antimicrobial agents should be selected for the pathogens detected. To improve the efficacy of treatment of hospitalized children with septicemia.
【作者单位】：攀枝花市中心医院儿科;
【分类号】：R446.5;R725.1

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