儿童血流感染患者病原菌及流行病学分析
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摘要
目的探讨儿童血流感染病原菌分布以及耐药情况,了解患儿临床流行病学,为临床合理使用抗菌药物提供依据。方法回顾性分析成都市第三人民医院2014年1月至2017年12月185例确诊为血流感染患儿的感染病原菌构成、抗菌药物及临床流行学分布情况。结果 185例患儿分离出188株病原菌,革兰氏阴性菌66株(35.1%),革兰氏阳性菌116株(61.7%),真菌6株(3.2%),新生儿以凝固酶阴性葡萄球菌为主,1～5岁以肺炎链球菌为主,药敏显示,耐甲氧西林金黄色葡萄球(MRSA)分离率为40.0%(6/15);耐甲氧西林凝固酶阴性葡萄球(MRCNS)分离率为65.6%(40/61),未检出耐万古霉素、利奈唑胺的葡萄球菌和肠球菌,大肠埃希菌与肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)菌株检出率分别为55.6%(10/18)和46.2%(6/13),产碳氢酶烯类肺炎克雷伯菌(CRKP)7.7%(1/13),并且不同年龄段患儿对青霉素、四环素以及三代头孢菌素耐药率差异有统计学意义(P<0.05),血流感染患主要为呼吸系统感染,其中肺炎49例(26.4%),上呼吸道感染18例(9.7%);其次新生儿黄疸35例(19.0%);早产儿30例(16.2%);尿路感染14例(7.6%);肠道感染12例(6.5%);脐周感染11例(5.9%);中耳炎7例(3.8%);脑膜炎5例(2.7%)等。结论本院不同年龄段致病菌分布不尽相同,抗菌药物耐药性监测对儿科临床合理用药和有效控制感染具有重要意义。
Objective To investigate the distribution and drug resistance of pathogenic bacteria in children with bloodstream infection and understand their clinical epidemiology so as to provide the evidence for the rational use of antibiotics in clinic.Methods The clinical data including the pathogenic bacteria composition,antibiotics and clinical epidemiological distribution of 185 children diagnosed with bloodstream infection in The Third People's Hospital of Chengdu from January of 2014 to December of 2017 were analyzed retrospectively.Results A total of188 strains of pathogenic bacteria were isolated from 185 children with bloodstream infection,and there were 66 strains of Gram-negative bacteria(35.1%),116 strains of Gram-positive bacteria(61.7%)and 6 strains of fungi(3.2%)among the 188 strains of pathogenic bacteria.The main pathogen was coagulase-negative staphylococci for the newborns and streptococcus pneumoniae for the children aged from 1 to 5 years old.According to the drug sensitivity analysis,the detection rates of methicillin-resistant staphylococcus aureus`(MRSA)and methicillinresistant coagulase-negative staphylococci(MRCNS)were 40.0%(6/15)and 65.6%(40/61)respectively.The vancomycin-resistant and linnezoamine-resistant strains of staphylococcus aureus and enterococcus were not detected.The detection rates of extended-spectrum B-lactamases(ESBLs)in Escherichia coli and Klebsiella pneumoniae were 55.6%(10/18)and 46.2%(6/13)respectively and that of catalase alkenes Klebsiella pneumoniae was 7.7%(1/13).The rates of the drug resistance to penicillin,tetracycline and third-generation cephalosporin were significantly different in children of different ages(P<0.05).The main infection in children with bloodstream infection was the respiratory infection with 49 cases of pneumonia(26.4%)and 18 cases of upper respiratory tract infection(9.7%).There were also 35 cases of neonatal jaundice(19.0%),30 cases of premature infants(16.2%),14 cases of urinary tract infection(7.6%),12 cases of intestinal infection(6.5%),11 cases of peripheral umbilicus infection(5.9%),7 cases of otitis media(3.8%)and 5 cases of meningitis(2.7%).Conclusion The distribution of pathogens significantly differs among the children of different ages,the surveillance of antimicrobial resistance is of great significance for the rational drug use and effective infection control in the pediatric clinic.
Objective To investigate the distribution and drug resistance of pathogenic bacteria in children with bloodstream infection and understand their clinical epidemiology so as to provide the evidence for the rational use of antibiotics in clinic.Methods The clinical data including the pathogenic bacteria composition,antibiotics and clinical epidemiological distribution of 185 children diagnosed with bloodstream infection in The Third People's Hospital of Chengdu from January of 2014 to December of 2017 were analyzed retrospectively.Results A total of188 strains of pathogenic bacteria were isolated from 185 children with bloodstream infection,and there were 66 strains of Gram-negative bacteria(35.1%),116 strains of Gram-positive bacteria(61.7%)and 6 strains of fungi(3.2%)among the 188 strains of pathogenic bacteria.The main pathogen was coagulase-negative staphylococci for the newborns and streptococcus pneumoniae for the children aged from 1 to 5 years old.According to the drug sensitivity analysis,the detection rates of methicillin-resistant staphylococcus aureus`(MRSA)and methicillinresistant coagulase-negative staphylococci(MRCNS)were 40.0%(6/15)and 65.6%(40/61)respectively.The vancomycin-resistant and linnezoamine-resistant strains of staphylococcus aureus and enterococcus were not detected.The detection rates of extended-spectrum B-lactamases(ESBLs)in Escherichia coli and Klebsiella pneumoniae were 55.6%(10/18)and 46.2%(6/13)respectively and that of catalase alkenes Klebsiella pneumoniae was 7.7%(1/13).The rates of the drug resistance to penicillin,tetracycline and third-generation cephalosporin were significantly different in children of different ages(P<0.05).The main infection in children with bloodstream infection was the respiratory infection with 49 cases of pneumonia(26.4%)and 18 cases of upper respiratory tract infection(9.7%).There were also 35 cases of neonatal jaundice(19.0%),30 cases of premature infants(16.2%),14 cases of urinary tract infection(7.6%),12 cases of intestinal infection(6.5%),11 cases of peripheral umbilicus infection(5.9%),7 cases of otitis media(3.8%)and 5 cases of meningitis(2.7%).Conclusion The distribution of pathogens significantly differs among the children of different ages,the surveillance of antimicrobial resistance is of great significance for the rational drug use and effective infection control in the pediatric clinic.
引文
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[8]郭予雄,孙跃玉,钟敏泉,等.儿科重症监护病房血管内导管相关性血流感染病原菌分布特点及耐药性分析[J].中华实用儿科临床杂志,2015,30(12):929-933.
[9]周聪,刘亚隽,张慧,等.儿童和成人血流感染病原菌分布及耐药性差异分析[J].中国消毒学杂志,2017,34(8):767-770.
[10]赵茂吉,辛力华,向瑶,等.2014-2015年四川省中医院血培养病原菌分布及耐药性分析[J].现代预防医学,2017,44(5):894-897.
[2]吕昕,王原,曹俊敏,等.医院血流感染病原菌分布及耐药性分析[J].国微生态学杂志,2015,27(3):310-312.
[3]俞晶晶,高锦孝.血流感染标本中的病原菌分布及耐药性分析[J].西北国防医学杂志,2015,36(3):192-194.
[4]樊淑珍,程学军,许晨,等.血流感染病人的病原菌分析[J].内蒙古医科大学报,2015,37(4):318-322.
[5]王卫平,孙锟,常立文.儿科学[M].9版.北京:人民卫生出版社,2018:182-184.
[6]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:568-571.
[7]李芳,仝晓宁,张祎,等.儿童血培养病原菌的分布及耐药性分析[J].中国妇幼健康研究,2016,27(2):174-177.
[8]郭予雄,孙跃玉,钟敏泉,等.儿科重症监护病房血管内导管相关性血流感染病原菌分布特点及耐药性分析[J].中华实用儿科临床杂志,2015,30(12):929-933.
[9]周聪,刘亚隽,张慧,等.儿童和成人血流感染病原菌分布及耐药性差异分析[J].中国消毒学杂志,2017,34(8):767-770.
[10]赵茂吉,辛力华,向瑶,等.2014-2015年四川省中医院血培养病原菌分布及耐药性分析[J].现代预防医学,2017,44(5):894-897.