2014-2019年郑州某儿童医院血流感染病原菌分布及耐药性分析(1)
摘 要 目的：分析鄭州某儿童医院血流感染病原菌分布及耐药性，为临床抗感染治疗合理选择药物提供参考。方法：采用回顾性分析方法，收集2014年10月-2019年9月郑州大学附属儿童医院住院患者血培养标本128 318份，统计分析其阳性率和血流感染患儿的临床症状及临床诊断，使用WHONET 5.6软件，统计阳性标本的病原菌菌种、送检科室和病原菌对临床主要抗菌药物的耐药性。结果：128 318份住院患者血培养标本中，阳性率为2.14%(2 746/128 318)。2 746份血培养阳性标本中，血流感染患儿主要症状为发热(1 986/2 746)，主要临床诊断包括脓毒血症(1 679/2 746)、支气管肺炎(858/2 746)、化脓性脑膜炎(555/2 746);主要送检科室包括新生儿诊疗中心(1 090株，占39.69%)[新生儿重症监护室(279株，占10.16%)、新生儿外科(223株，占8.12%)、新生儿内科(209株，占7.61%)、小婴儿科(200株，占7.28%)及早产儿科(179株，占6.52%)]、血液肿瘤科(216株，占7.87%)、心血管内科(206株，占7.50%);病原菌为革兰氏阳性菌的占72.80%、革兰氏阴性菌的占24.21%、真菌的占2.99%。在革兰氏阳性菌中，凝固酶阴性葡萄球菌(1 414株)、金黄色葡萄球菌(146株)最为常见，前者对青霉素G、苯唑西林、红霉素耐药率均>80%，后者对青霉素G、红霉素耐药率均>80%;在革兰氏阴性菌中，肺炎克雷伯菌(183株)、大肠埃希菌(172株)最为常见，前者对氨苄西林、哌拉西林、氨苄西林/舒巴坦、头孢唑啉耐药率均>80%，后者对氨苄西林、四环素耐药率均>80%;在真菌中，白色念珠菌(42株)、近平滑念珠菌(22株)最为常见，对常用抗真菌药物的耐药率均<10%。结论：该院血流感染病原菌种类复杂，以凝固酶阴性葡萄球菌、肺炎克雷伯菌为主，耐药情况严峻。
关键词 儿童医院;血流感染;病原菌;耐药性
中图分类号 R37;R969.3 文献标志码 A 文章编号 1001-0408(2020)01-0098-06
DOI 10.6039/j.issn.1001-0408.2020.01.17
ABSTRACT OBJECTIVE： To analyze the distribution and drug resistance of bloodstream infection pathogens in a Children’s Hospital from Zhengzhou， and to provide reference rational selection of drugs in anti-infective treatment. METHODS： By retrospective analysis， 128 318 blood culture specimens were collected from inpatients in the Affiliated Children’s Hospital of Zhengzhou University from Oct. 2014 to Sept. 2019. The positive rate， clinical symptoms and clinical diagnosis of children with bloodstream infection were analyzed statistically. WHONET 5.6 software was used to analyze pathogenic bacteria of positive specimen， the departments and the resistance of pathogens to the main clinical antibiotics. RESULTS： In 128 318 blood culture samples of inpatients， the positive rate was 2.14% (2 746/128 318); among 2 746 blood culture positive sample， the main symptom of childrem with blood stream infection was fever (1 986/2 746); main clinical diagnosis included sepsis (1 679/2 746)， bronchopneumonia (858/2 746)， purulent meningitis (555/2 746). The main departments included neonatal diagnosis and treatment center (1 090 strains， accounting for 39.69%) [neonatal intensive care unit (279 strains， accounting for 10.16%)， neonatal surgery department (223 strains， accounting for 8.12%)， neonatal internal medicine department (209 strains， accounting for 7.61%)， infant pediatrics department (200 strains， accounting for 7.28%) and premature pediatrics department (179 strains， accounting for 6.52%)]， hematology oncology department (216 strains， accounting for 7.87%)， cardio vascular medicine department (206 strains， accounting for 7.50%). Gram-positive bacteria accounted for 72.80%， Gram-negative bacteria 24.21%， fugus 2.99%. Among Gram-positive bacteria， coagulase negative staphylococcus (1 414 strains) and Staphylococcus aureus (146 strains) were the most common. The resistance rate of the former to penicillin G， oxacillin and erythromycin was more than 80%， and that of the latter to penicillin G and erythromycin was more than 80%. Among Gram-negative bacteria， Klebsiella pneumoniae (183 strains) and Escherichia coli (172 strains) were the most common. The resistance rates of the former to ampicillin， piperacillin， ampicillin/sulbactam and cefazolin were more than 80%， and the latter to ampicillin and tetracycline were more than 80%. Among the fungus， Candida albicans (42 strains) and Candida parapsilosis (22 strains) were the most common， and the resistance rate to common antifungal drugs was less than 10%. CONCLUSIONS： The pathogens of bloodstream infection in the hospital are complex， mainly coagulase negative staphylococcus and K. pneumoniae， and the drug resistance is severe., 百拇医药(方盼盼 杨俊文 高凯杰 杨俊梅 孙红启 王颍源)
关键词 儿童医院;血流感染;病原菌;耐药性
中图分类号 R37;R969.3 文献标志码 A 文章编号 1001-0408(2020)01-0098-06
DOI 10.6039/j.issn.1001-0408.2020.01.17
ABSTRACT OBJECTIVE： To analyze the distribution and drug resistance of bloodstream infection pathogens in a Children’s Hospital from Zhengzhou， and to provide reference rational selection of drugs in anti-infective treatment. METHODS： By retrospective analysis， 128 318 blood culture specimens were collected from inpatients in the Affiliated Children’s Hospital of Zhengzhou University from Oct. 2014 to Sept. 2019. The positive rate， clinical symptoms and clinical diagnosis of children with bloodstream infection were analyzed statistically. WHONET 5.6 software was used to analyze pathogenic bacteria of positive specimen， the departments and the resistance of pathogens to the main clinical antibiotics. RESULTS： In 128 318 blood culture samples of inpatients， the positive rate was 2.14% (2 746/128 318); among 2 746 blood culture positive sample， the main symptom of childrem with blood stream infection was fever (1 986/2 746); main clinical diagnosis included sepsis (1 679/2 746)， bronchopneumonia (858/2 746)， purulent meningitis (555/2 746). The main departments included neonatal diagnosis and treatment center (1 090 strains， accounting for 39.69%) [neonatal intensive care unit (279 strains， accounting for 10.16%)， neonatal surgery department (223 strains， accounting for 8.12%)， neonatal internal medicine department (209 strains， accounting for 7.61%)， infant pediatrics department (200 strains， accounting for 7.28%) and premature pediatrics department (179 strains， accounting for 6.52%)]， hematology oncology department (216 strains， accounting for 7.87%)， cardio vascular medicine department (206 strains， accounting for 7.50%). Gram-positive bacteria accounted for 72.80%， Gram-negative bacteria 24.21%， fugus 2.99%. Among Gram-positive bacteria， coagulase negative staphylococcus (1 414 strains) and Staphylococcus aureus (146 strains) were the most common. The resistance rate of the former to penicillin G， oxacillin and erythromycin was more than 80%， and that of the latter to penicillin G and erythromycin was more than 80%. Among Gram-negative bacteria， Klebsiella pneumoniae (183 strains) and Escherichia coli (172 strains) were the most common. The resistance rates of the former to ampicillin， piperacillin， ampicillin/sulbactam and cefazolin were more than 80%， and the latter to ampicillin and tetracycline were more than 80%. Among the fungus， Candida albicans (42 strains) and Candida parapsilosis (22 strains) were the most common， and the resistance rate to common antifungal drugs was less than 10%. CONCLUSIONS： The pathogens of bloodstream infection in the hospital are complex， mainly coagulase negative staphylococcus and K. pneumoniae， and the drug resistance is severe., 百拇医药(方盼盼 杨俊文 高凯杰 杨俊梅 孙红启 王颍源)
参见：首页 > 医疗版 > 疾病专题 > 传染科 > 流行性感冒