| 摘要: |
| 目的:了解昆明地区2012-2015年儿童血源性感染细菌构成及耐药特点。方法:收集2012-2015年昆明市儿童医院住院患儿送检的血培养标本共37 505例,采用BACT ALERT 3D全自动血培养仪检测,按照《全国临床检验操作规程》鉴定细菌菌种。药敏试验采用纸片扩散法,结果按美国国家临床实验室标准委员会(NCCLS)2000年版标准判断。结果:37 505例血培养标本共检出细菌1 240株,检出率3.3%,前5位检出细菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、沙门菌。凝固酶阴性葡萄球菌耐甲氧西林菌株检出率为81.5%(327/401),耐甲氧西林金黄色葡萄球菌检出率为20.0%(8/40),产ESBLs大肠埃希菌检出率为51.4%(92/179),产ESBLs肺炎克雷伯菌检出率为63.2%(42/66)。金黄色葡萄球菌对青霉素的耐药率为100%,对苯唑西林及头孢唑林的耐药率呈下降趋势,对红霉素及克林霉素不同程度耐药;凝固酶阴性葡萄球菌对青霉素、苯唑西林、头孢唑林、红霉素、克林霉素耐药率较高;未检出对万古霉素耐药菌株。大肠埃希菌和肺炎克雷伯菌对氨苄西林、头孢唑林、哌拉西林、头孢噻肟的耐药率较高,其ESBLs(+)菌株中甚至检出对亚胺培南或美罗培南的耐药菌株;沙门菌对常用抗生素的耐药率均较低。结论:昆明地区2012-2015年儿童血源性感染细菌以凝固酶阴性葡萄球菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、沙门菌为主,治疗应结合本地区近年来的病原菌谱及耐药特点,合理使用抗菌药物,减少耐药菌株的产生。 |
| 关键词: 儿童 血源性感染 病原菌 抗生素 耐药性监测 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2018.09.015 |
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| 基金项目: |
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| Bacterial Spectrum and Drug Resistance of Blood-Borne Infections in Children in Kunming from 2012 to 2015 |
| Li Bin, Zhang Tiesong, Xiao Shufang, Zhou Lin, Su Min |
| (Children's Hospital of Kunming, Yunnan Kunming 600034, China) |
| Abstract: |
| Objective: To investigate the bacterial spectrum and drug resistance of blood-borne infections in children in Kunming area from 2012 to 2015. Methods: Totally 37,505 cases of blood culture specimens from inpatient of Children’s Hospital of Kunming from 2012 to 2015 were collected. BACT ALERT 3D automatic blood culture instrument was used to detect bacterial strains according to the National Clinical Laboratory Procedures. The drug susceptibility test was performed by using a disk diffusion method, and the results were judged according to the National Clinical Laboratory Standards Committee (NCCLS) (2000 Edition). Results: A total of 1,240 strains of bacteria were detected in 37,505 blood culture specimens, and the detection rate was 3.3%. The top detected 5 bacteria were respectively coagulase-negative staphylococci, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae and Salmonella. The detection rate of coagulase-negative staphylococci-resistant methicillin was 81.5%(327/401), methicillin-resistant Staphylococcus aureus was 20.0%(8/40), ESBLs-producing Escherichia coli was 51.4%(92/179), and Klebsiella pneumoniae producing ESBLs was 63.2%(42/66). The resistance rate of Staphylococcus aureus to penicillin was 100%, the resistance rates to benzoxilin and cefazolin were in a decreasing trend, and the resistance to erythromycin and clindamycin was in differevt degree; Coagulase-negative staphylococci had higher resistance rates to penicillin, oxacillin, cefazolin, erythromycin, and clindamycin; and no vancomycin-resistant strains were detected. Escherichia coli and Klebsiella pneumoniae had higher drug resistance rates to ampicillin, cefazolin, piperacillin and cefotaxime, and even the resistant strain to imipenem or meropenem was detected in its ESBLs(+) strain. The resistance rate of Salmonella to commonly used antibiotics was low. Conclusion: The blood-borne infections of children in Kunming from 2012 to 2015 are mainly coagulase-negative staphylococci, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae and Salmonella. The treatment should be combined with the pathogen spectrum of the region in recent years, the characteristics of drug resistance and the rational use of antibiotics, so as to reduce the emergence of drug-resistant strains. |
| Key words: children blood-borne infections pathogenic bacteria antibiotics drug resistance surveillance |
