目的 探讨儿科住院患儿多重耐药菌感染的情况及对抗菌药的耐药性,为临床合理应用抗菌药提供理论依据.方法 对2019年1月至2022年12月在海口市妇幼保健院儿科住院多重耐药菌感染的175例患儿临床资料进行回顾性分析.结果 9376例患儿共分离病原菌1846株,检出多重耐药菌175株.175例患儿中,男102例,女73例,年龄1个月至5岁,＜1岁56例,1～3岁107例,＞3岁12例.175株多重耐药菌中,革兰氏阳性菌107株,占61.14％,革兰氏阳性菌中耐甲氧西林金黄色葡萄球菌97株(55.43％),其次是产超广谱β-内酰胺类酶(ESBLs)肺炎克雷伯菌和产ESBLs大肠埃希菌,分别为35株(20.00％)和27株(15.43％).在标本的类型中,以痰液为主,为163株(93.15％),其次为大便9株(5.14％),药敏结果示耐甲氧西林金黄色葡萄球菌对青霉素、红霉素、头孢西丁、替加环素、苯唑西林、克林霉素耐药率100％,对万古霉素、利福平、利奈唑胺敏感率90％以上;表皮葡萄球菌对青霉素、红霉素、头孢西丁、苯唑西林、替加环素耐药率100％,对万古霉素、利福平、利奈唑胺敏感率80％以上.肺炎克雷伯菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、头孢替坦、头孢他啶耐药率80％及以上,对亚胺培南和厄他培南敏感率70％以上;大肠埃希菌对氨苄西林、氨苄西林/舒巴坦、头孢曲松、头孢唑啉耐药率80％以上,对亚胺培南和厄他培南敏感.结论 住院患儿多重耐药菌主要发生在1～3岁呼吸道感染的患儿,检测出的多重耐药菌耐药现象严重,应加强对此类患儿的管理及加强对多重耐药菌的检测和耐药性监测,合理使用抗菌药,预防多重耐药菌的产生.
Objective To investigate the infection situation of multi-drug resistant bacteria and their resistance to antibiotics in pediatric inpatients,so as to provide theoretical basis for rational medication of antibiotics in clinical practice.Methods The clinical data of 175 pediatric patients with multi-drug resistant bacteria infection hospitalized in the Department of Pediatrics in Haikou Hospital of Maternal and Child Health from January 2019 to December 2022 were analyzed retrospectively.Results A total of 1846 strains of pathogenic bacteria were isolated from 9376 pediatric patients,and 175 strains of multi-drug resistant bacteria were detected.In the 175 pediatric patients,there were 102 males and 73 females,ranging in age from 1 month to 5 years,in which 56 cases were under 1 year,107 cases were between 1 and 3 years,and 12 cases were over 3 years.In 175 strains of multi-drug resistant bacteria,107 strains were Gram-positive bacteria,accounting for 61.14％,97 strains(accounting for 55.43％)were methicillin resistant Staphylococcus aureus,followed by Klebsiella pneumoniae producing extended-spectrum β-lactamases(ESBLs)and Escherichia coli producing ESBLs,with 35 strains(accounting for 20.00％)and 27 strains(accounting for 15.43％)respectively.In the types of specimens,163 strains(accounting for 93.15％)were sputum,followed by 9 strains(accounting for 5.14％)of stool.The drug sensitivity results showed that Staphylococcus aureus had 100％resistance rates to penicillin,erythromycin,cefoxitin,tigecycline,oxacillin,and clindamycin,and sensitivity rates of over 90％to vancomycin,rifampicin,and linezolid.The resistance rates of Staphylococcus epidermidis to penicillin,erythromycin,cefoxitin,oxacillin and tigecycline were 100％,and the sensitivity rates to vancomycin,rifampicin and linezolid were 80％.The resistance rates of Klebsiella pneumoniae to ampicillin,ampicillin/sulbactam,cefazolin,cefotetan and ceftazidime were 80％and above,and the sensitivity rates to imipenem and ertapenem were over 70％.The resistance rates of Escherichia coli to ampicillin,ampicillin/sulbactam,ceftriaxone and cefazolin were over 80％,and it was sensitive to imipenem and ertapenem.Conclusion Multi-drug resistant bacteria in pediatric inpatients mainly occur in children with respiratory tract infection aged 1-3 years,and the drug resistance of multi-drug resistant bacteria detected is serious.We should strengthen the management of such children,strengthen the detection and drug resistance monitoring of multi-drug resistant bacteria,and rationally use antibiotics to prevent the emergence of multi-drug resistant bacteria.
胡祥英;任翼;何娜;吴奇发
海南省海口市妇幼保健院儿科,海南海口 570102
临床医学
多重耐药菌;细菌;抗菌药;广谱β-内酰胺酶
Multi-drug resistant bacteria;Bacteria;Antibacterial drugs;Broad spectrum β-lactamase
《中国医药科学》 2024 (012)
59-62 / 4
海南省卫生健康行业科研项目(20A200345).
10.20116/j.issn2095-0616.2024.12.14
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