摘要
目的了解2011年<14岁儿童细菌感染的常见病原菌及耐药性,为临床合理用药提供参考。方法 49所Mohnarin成员单位对>14岁儿童临床分离的病原菌进行常规鉴定,采用纸片扩散法(K-B法)或自动化细菌鉴定系统测定细菌的耐药性,按CLSI 2010年版标准判断结果并采用WHONET5.6软件进行统计分析。结果共分离10 857株细菌,其中革兰阴性菌占58.8%,革兰阳性菌占41.2%;前5位分离菌依次为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、肺炎链球菌、铜绿假单胞菌,分别占14.5%、13.4%、12.4%、6.4%、5.8%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别为34.9%、81.3%,未检测到万古霉素耐药株,非脑脊液标本中青霉素不敏感肺炎链球菌(PNSP)检出率为18.9%,β-溶血链球菌对万古霉素、青霉素、头孢曲松、头孢噻肟均高度敏感,对大环内酯类药物的耐药率均>70.0%;万古霉素耐药粪肠球菌和屎肠球菌检出率为1.5%、2.4%;大肠埃希菌、克雷伯菌属产超广谱β-内酰胺酶(ESBLs)的检出率分别为78.2%、65.4%,肠杆菌科细菌对亚胺培南和美罗培南仍保持较高的敏感性,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率<15.0%;铜绿假单胞菌对多数抗菌药物耐药率<20.0%,鲍氏不动杆菌对米诺环素、头孢哌酮/舒巴坦耐药率较低,分别为16.9%、23.0%,对美罗培南、亚胺培南耐药率分别为42.0%、47.8%;流感嗜血菌β-内酰胺酶阳性率为42.6%,对阿莫西林/克拉维酸、环丙沙星、阿奇霉素、头孢呋辛、头孢噻肟耐药率<10.0%,对氨苄西林耐药率为50.7%。结论儿童分离菌中耐药性仍呈增长趋势,对临床构成严重威胁,合理选用抗菌药物,加强感染控制是当务之急。
OBJECTIVE To investigate the distribution and drug resistance of the common pathogens isolated from the patients aged less than 14years so as to provide reference for reasonable clinical medication.METHODS The bacterial isolates from patients under 14 years old in 49 Mohnarin member hospitals were collected,and antimicrobial susceptibility testing was carried out by Kirby-bauer（K-B） method or automatic microbiological examining system,and the data were analyzed by whonet 5.6software referring to CLSI 2010breakpoints.RESULTS A total of 10 857clinical isolates were collected in 2011,the gram-negative bacilli and gram-positive cocci accounted for 58.8% and 41.2%,respectively.The most common isolates were Escherichia coli（14.5%）,Staphylococus aureus（13.4%）,Klebsiellia pneumoniae（12.4%）,Streptococcus pneumoniae（6.8%）,Pseudomonas aeruginosa（5.8%）.The detection rate of methicillin-resistant isolates in S.aureus（MRSA） was 34.9% and 81.3% in coagulase-negative Staphylococcus（MRCNS）,no vancomycin-resistant isolate was found.The prevalence of penicillin non-susceptible S.pneumoniae（PNSP） in non-meningitis isolates was 18.9%,Streptococcus spp β-hemolytic were highly sensitive to vancomycin,penicillin,cefotaxime,ceftriaxone,and the drug resistance rates of Streptococcus sppto macrolides were over 70.0%.The detection rates of E.faecalis and E.faecium strains resistant to vancomycin were 1.5% and 2.4%.The prevalence of extended-spectrum β lactamases（ESBLs） was 78.2%in E.coli,65.4%in Klebsiella spp.Imipenem and meropenem were the most potent antimicrobial agents against Enterobacteriaceae,the drug resistance rates to cefoperazone-sulbactum and piperacillin-tazobactam were also less than 15.0%.The drug resistance rates of P.aerugionsa to most antmicrobial agents were less than 20.0%.The resistant rates to minocycline and cefoperazone-sulbactam（16.9% and 23.0%respectively） were the lowest in A.baumanii,while the resistant rates to imipenem and meropenem being 42.0%and 47.8%.The positive rate of β-1actamase in H.influenzaisolates was 42.6%,no more than 10.0% of these strains were resistant to amoxicillin-clavulanic acid,ciprofloxacin,azithromycin,cefuroxime,or cefotaxime,50.7% of the strains were resistant to ampicillin.CONCLUSION The drug resistance of the strains isolated from the children keeps an upward tendency,which threatens the hospital.It is urgent to reasonably use antibiotics and strengthen the infection control.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2012年第24期5488-5492,共5页
Chinese Journal of Nosocomiology
基金
卫生行业专科研专项项目(201002021)
作者简介
通讯作者：肖永红，E-mail：xiao-yonghong@163．com
通讯作者：李兰娟，E-mail：ljli@zju．edu．cn
