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JI Xing; XU Jin; YU Wenliang

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- China Pharmacy Vol. 27, Issue 35, (2016)
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JI Xing, XU Jin, YU Wenliang. [J]. China Pharmacy 27(35).(2016)
DOI：

JI Xing, XU Jin, YU Wenliang. [J]. China Pharmacy 27(35).(2016) DOI：

摘要

目的：分析我院儿童严重脓毒症的病原菌分布及其耐药情况，为临床合理使用抗菌药物提供依据。方法：选择2014年1月－2015年5月我院儿童监护病房收治的严重脓毒症患儿57例，对其病原学培养及药敏试验结果进行回顾性分析。结果：57例患儿中，有18例检出病原菌（31.58％）；共检出病原菌91株，其中以葡萄球菌、肠球菌为主的革兰氏阳性（G+）菌24株（26.37％），以肺炎克雷伯菌、醋酸钙鲍曼复合不动杆菌为主的革兰氏阴性（G－）菌60株（65.93％），均为假丝酵母菌的真菌7株（7.69％）。检出耐甲氧西林葡萄球菌4株，耐碳青霉烯类肺炎克雷伯菌22株，多重耐药肺炎克雷伯菌21株，多重耐药醋酸钙鲍曼复合不动杆菌7株。耐甲氧西林葡萄球菌、金黄色葡萄球菌和肺炎链球菌对万古霉素和利奈唑胺敏感，耐药率为0；肺炎克雷伯菌对氨苄西林钠舒巴坦钠、哌拉西林钠他唑巴坦钠、亚胺培南和头孢菌素类抗菌药物的耐药率均为100％；醋酸钙鲍曼复合不动杆菌对大部分常用抗菌药物的耐药率＞50％；大肠埃希菌除对头孢噻肟耐药外，对其他抗菌药物的耐药率≤40％。结论：我院儿童严重脓毒症的主要病原菌为G－菌，且检出了耐碳青霉烯类肺炎克雷伯菌，临床应予以重视；对于由多重耐药菌引起的严重脓毒症患儿应采取多药联合治疗策略，且应根据病原菌种类和药敏试验结果合理选择抗菌药物。

Abstract

OBJECTIVE： To analyze bacteria distribution and drug resistance of pediatric severe sepsis in our hospital， and to provide reference for clinical rational use of antimicrobial agents. METHODS： 57 pediatric severe sepsis patients were collected from pediatric intensive care unit of our hospital during Jan. 2014 to May 2015. The results of pathogen culture and drug sensitivity tests were analyzed retrospectively. RESULTS： Of 57 children， pathogen were detected in 18 cases （31.58％）. A total of 91 pathogen were detected， of which there were 24 strains of Gram-positive （G+） bacteria （26.37％） mainly including Staphylococcus and Enterococcus， 60 strains of Gram-negative （G－） bacteria （65.93％） mainly including Klebsiella pneumoniae and Acinetobacter calcoacetcus-A. baumannii complex and 7 strains of fungus （7.69％） as Candida. 4 strains of methicillin-resistant Staphylococcus， 22 strains of carbapenems-resistant K. pneumoniae， 21 strains of multi-drug resistant K. pneumoniae and 7 strains of multi-drug resistant A. calcoacetcus-A. baumannii complex were all detected. Methicillin-resistant Staphylococcus， Staphylococcus aureus and Streptococcus pneumoniae were sensitive to vancomycin and linezolid， with resistant rate of 0. K. pneumoniae was completely resistant to ampicillin sodium and sulbactam sodium， piperacillin sodium and tazobactam sodium， imipenem and cephalosporin， with resistant rate of 100％. Resistant rate of A. calcoacetcus-A. baumannii complex to major common antimicrobial agents was higher than 50％. Escherichia coli was resistant to cefotaxime， and resistant rates of other antimicrobial agents were lower than 40％. CONCLUSIONS： Main pathogen of pediatric severe sepsis is G－ bacteria in our hospital， and carbapenems-resistant K. pneumoniae is detected， to which should be pay attention. The multiple drug-resistant treatment should be adopted for pediatric severe sepsis caused by multiple drug-resistant bacteria. Antimicrobial agents should be selected rationally according to pathogen type and the results of drug sensitivity test.

关键词

儿童严重脓毒症病原菌分布耐药性分析

Keywords

Pediatric severe sepsisPathogenDistributionAnalysis of drug resistance

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