某三级妇幼保健院住院患儿常见病原体的检出情况及耐药变迁趋势
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摘要
目的调查分析长治市妇幼保健院儿科病区送检标本中分离的常见细菌与耐药变迁趋势,为指导临床合理使用抗菌药物提供参考和依据。方法参照《全国临床检验操作规程》第四版,对2015年1月至2017年12月长治市妇幼保健院各儿童科室住院患儿不同来源的送检标本进行细菌培养与药敏试验,以阳性菌检出率和药物敏感率为观察指标,分析比较细菌阳性检出情况变化和细菌药物敏感变迁趋势。结果送检标本的来源以痰、血液及咽拭子为主。3年间痰和咽拭子样本的阳性菌检出率逐年降低,但痰样本的阳性菌检出率降幅较小[由2015年的24.90%(718/2 884)降低到2017年的21.67%(705/3 254)],咽拭子样本的阳性菌检出率降幅较大[由2015年的24.52%(540/2 202)降低到2017年的12.79%(162/1 267)];血培养阳性菌检出率则呈增加趋势:从2015年的1.56%(29/1 864)增加到2017年的3.22%(79/2 457)。从痰、咽拭子、血液标本中共分离出3 407株阳性病原菌,其中以革兰氏阴性菌中的大肠埃希菌、肺炎克雷伯菌、产气肠杆菌、鲍曼不动杆菌以及革兰氏阳性菌中的金黄色葡萄球菌、肺炎链球菌为主。而肺炎链球菌检出占比呈明显的逐年增高趋势:由2015年的4.27%(55/1 287)增高至2017年的19.84%(188/946)。结论细菌检出阳性率与送检标本量呈正相关,通过细菌药物敏感性变化趋势的检测,可以有效指导临床合理使用抗菌药物,延缓或减少细菌耐药的发生。
Objective To investigate and analyze the changing trend of common bacteria and drug resistance in the samples sent to paediatric ward, so as to provide reference for clinical rational use of antibiotics in clinic. Methods According to the National Guide To Clinical Laboratory Procedures(The fourth edition), bacterial culture and drug sensitivity tests were conducted on samples from different sources of hospitalized children in the Departments of Pediatrics, Changzhi Maternal and Child Health Hospital from January 2015 to December 2017. The positive bacteria detection rate and drug sensitivity rate were used as observation indexes to analyze and compare the changes of positive bacteria detection and anti-bacterial drug sensitivity. Results The samples were mainly from sputum, blood and swab of pharynx. The positive bacteria detection rate of sputum and pharyngeal swab samples decreased year by year within 3 years, but the positive bacteria detection rate of sputum samples decreased slightly from 24.90% in 2015(718/2 884) to 21.67% in 2017(705/3 254). The positive bacteria detection rate of pharyngeal swab samples decreased significantly from 24.52%(540/2 202) in 2015 to 12.79%(162/1 267) in 2017. The detection rate of positive bacteria in blood culture showed an increasing trend: it increased from 1.56%(29/1 864) in 2015 to 3.22%(79/2 457) in 2017. A total of 3 407 strains of positive pathogenic bacteria were isolated from sputum, pharyngeal swabs and blood specimens, among which E. coli, Klebsiella pneumoniae, Enterobacter pneumoniae, Acinetobacter baumannii and Staphylococcus aureus and Streptococcus pneumoniae in gram-negative bacteria were the main pathogens. The detection rate of Streptococcus pneumoniae showed an obvious increasing trend year by year: It increased from 4.27%(55/1 287) in 2015 to 19.84%(188/946) in 2017. Conclusion The positive rate of bacterial detection is positively correlated with the number of samples submitted for examination. By detecting the change trend of bacterial drug sensitivity, it can effectively guide clinical rational use of antimicrobial agents and delay or reduce the occurrence of bacterial drug resistance.
Objective To investigate and analyze the changing trend of common bacteria and drug resistance in the samples sent to paediatric ward, so as to provide reference for clinical rational use of antibiotics in clinic. Methods According to the National Guide To Clinical Laboratory Procedures(The fourth edition), bacterial culture and drug sensitivity tests were conducted on samples from different sources of hospitalized children in the Departments of Pediatrics, Changzhi Maternal and Child Health Hospital from January 2015 to December 2017. The positive bacteria detection rate and drug sensitivity rate were used as observation indexes to analyze and compare the changes of positive bacteria detection and anti-bacterial drug sensitivity. Results The samples were mainly from sputum, blood and swab of pharynx. The positive bacteria detection rate of sputum and pharyngeal swab samples decreased year by year within 3 years, but the positive bacteria detection rate of sputum samples decreased slightly from 24.90% in 2015(718/2 884) to 21.67% in 2017(705/3 254). The positive bacteria detection rate of pharyngeal swab samples decreased significantly from 24.52%(540/2 202) in 2015 to 12.79%(162/1 267) in 2017. The detection rate of positive bacteria in blood culture showed an increasing trend: it increased from 1.56%(29/1 864) in 2015 to 3.22%(79/2 457) in 2017. A total of 3 407 strains of positive pathogenic bacteria were isolated from sputum, pharyngeal swabs and blood specimens, among which E. coli, Klebsiella pneumoniae, Enterobacter pneumoniae, Acinetobacter baumannii and Staphylococcus aureus and Streptococcus pneumoniae in gram-negative bacteria were the main pathogens. The detection rate of Streptococcus pneumoniae showed an obvious increasing trend year by year: It increased from 4.27%(55/1 287) in 2015 to 19.84%(188/946) in 2017. Conclusion The positive rate of bacterial detection is positively correlated with the number of samples submitted for examination. By detecting the change trend of bacterial drug sensitivity, it can effectively guide clinical rational use of antimicrobial agents and delay or reduce the occurrence of bacterial drug resistance.
引文
1 赵旭,严向明,王秀珍,等.某儿童医院连续3年住院患儿医院感染现患率调查[J].中国消毒学杂志,2015,32(1):40- 43.
2 印爱珍,马乐龙,邓莉,等.儿童医院医院感染横断面调查[J].中国感染控制杂志,2015,14(11):769- 771 .
3 许渝,徐润琳,王文娟,等.某儿童医院医院感染现患率调查[J].中国消毒学杂志,2017,34(10):953- 954,958.
4 李六亿,贾会学,贾建侠,等.某综合医院多药耐药菌医院感染调查与分析[J].中华医院感染学杂志,2011,21(12):2582- 2584.
5 Lepelletier D,Orsonneau JL,Blin A,et al.Bacterial and epidemiologic study of the resistance to oxyiminocephalosporins in Escherichia coli in a French hospital[J].Clin Microbiol Infect,1999,5(1):37- 46.
6 邓春,姚长军,胡燕,等.新生儿肺炎克雷伯杆菌肺炎的临床特征及药敏试验研究(附124例病例报告)[J].新生儿科杂志,2000,15(5):205- 206,208.
7 赵丽.儿童重症监护室细菌感染病原学及耐药性分析[J].中国卫生标准管理,2018,9(23):126- 128.
8 辜裕光.医院鲍曼不动杆菌分布及耐药性监测分析[J].中国现代药物应用,2018,12(24):202- 204.
9 杨斌,高萃,姜泓.儿童重症肺炎下呼吸道细菌的分布及耐药分析[J].中国妇幼保健,2018,33(24):5830- 5833.
10 王卫平,毛萌,李廷玉,等.儿科学[M].8版.北京:人民卫生出版社,2013:1- 473.
11 冯淑芳.痰培养标本采集时间与采集方法对支气管肺炎患儿标本质量的影响[J].齐鲁护理杂志,2016,22(9):96- 98.
12 李燕.儿童医院多重耐药菌管理的药学方法[J].北方药学,2019,16(2):183- 185.
13 谢梦瑶,袁拥华,刘丽梅,等.儿童哮喘与1岁以内使用抗菌药物的关系的Meta分析[J].中国当代儿科杂志,2016,18(10):995- 1000.
2 印爱珍,马乐龙,邓莉,等.儿童医院医院感染横断面调查[J].中国感染控制杂志,2015,14(11):769- 771 .
3 许渝,徐润琳,王文娟,等.某儿童医院医院感染现患率调查[J].中国消毒学杂志,2017,34(10):953- 954,958.
4 李六亿,贾会学,贾建侠,等.某综合医院多药耐药菌医院感染调查与分析[J].中华医院感染学杂志,2011,21(12):2582- 2584.
5 Lepelletier D,Orsonneau JL,Blin A,et al.Bacterial and epidemiologic study of the resistance to oxyiminocephalosporins in Escherichia coli in a French hospital[J].Clin Microbiol Infect,1999,5(1):37- 46.
6 邓春,姚长军,胡燕,等.新生儿肺炎克雷伯杆菌肺炎的临床特征及药敏试验研究(附124例病例报告)[J].新生儿科杂志,2000,15(5):205- 206,208.
7 赵丽.儿童重症监护室细菌感染病原学及耐药性分析[J].中国卫生标准管理,2018,9(23):126- 128.
8 辜裕光.医院鲍曼不动杆菌分布及耐药性监测分析[J].中国现代药物应用,2018,12(24):202- 204.
9 杨斌,高萃,姜泓.儿童重症肺炎下呼吸道细菌的分布及耐药分析[J].中国妇幼保健,2018,33(24):5830- 5833.
10 王卫平,毛萌,李廷玉,等.儿科学[M].8版.北京:人民卫生出版社,2013:1- 473.
11 冯淑芳.痰培养标本采集时间与采集方法对支气管肺炎患儿标本质量的影响[J].齐鲁护理杂志,2016,22(9):96- 98.
12 李燕.儿童医院多重耐药菌管理的药学方法[J].北方药学,2019,16(2):183- 185.
13 谢梦瑶,袁拥华,刘丽梅,等.儿童哮喘与1岁以内使用抗菌药物的关系的Meta分析[J].中国当代儿科杂志,2016,18(10):995- 1000.