南京儿童医院PICU病原菌流行分布与耐药性分析

目的了解南京地区儿童重症监护病房（PICU）临床分离病原菌的流行分布与其对抗生素的耐药趋势,指导临床诊断及用药。方法回顾性分析2011年1月至2013年12月南京医科大学附属南京儿童医院PICU住院患儿所分离出病原菌的分布和药物敏感性试验结果。结果 1 476例各类送检标本中共分离出386株病原菌（26.2%）,其中革兰阴性杆菌265株（68.7%）,主要为肺炎克雷白杆菌,大肠埃希菌和鲍曼不动杆菌;革兰阳性球菌93株（24.1%）,主要为凝固酶阴性葡萄球菌,金黄色葡萄球菌和肺炎链球菌;真菌28株（7.2%）。3年中产超广谱β-内酰胺酶（ESBLs）的肺炎克雷伯菌和大肠埃希菌分别占62.7%和54.9%。革兰阴性杆菌对亚胺培南、阿米卡星和头孢哌酮/舒巴坦较敏感;革兰阳性球菌对万古霉素和利奈唑胺较敏感。结论 PICU分离出的主要病原菌对常规抗菌药物的耐药现象严重,应结合患儿临床表现、感染部位和病原菌的流行病学特点合理选用抗菌药物。

Analysis of distribution and drug resistance of pathogens from pediatric intensive care unit of Nanjing Children's Hospital

Objective To investigate the distribution and antibiotic resistance of pathogenic bacteria from pediatric intensive care unit（ PICU） in the area of Nanjing,and guide clinical diagnosis and selection of antibiotics. Methods Distribution and antibiotic resistance of pathogenic bacteria isolated from PICU in Nanjing Children＇s Hospital Affiliated to Nanjing Medical University from Jan. 2011 to Dec. 2013 were analyzed retrospectively. Results 386 strains of pathogenic bacteria were isolated（ 26. 2%）. There were 265（ 68. 7%） Gram negative bacteria and the most common gram negative bacillus were Klebsiella pneumoniae,Escherichia coli and Acinetobacter baumannii;Gram positive bacteria accounted for 93（ 24. 1%） and the most common gram positive bacillus were coagulase negative Staphylococci,Staphylococcus aureus and Streptococcus pneumoniae; 28 strains（ 7. 2%） were fungi. There were 62. 7% of ESBLs-producing Escherichia coli and 54. 9% of ESBLs-producing Klebsiella pneumoniae within the three years. Gram negative bacilli were sensitive to imipenem,amikacin and cefoperazone / sulbactam while gram positive bacilli were sensitive to vancomycin and linezolid. Conclusion The drug resistance of main pathogenic bacteria isolated from PICU to common antibiotics tend to increase. Antibiotics should be used rationally according to clinical manifestation,infection site,and epidemiological characteristics of pathogenic bacteria.