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目的探讨成都地区小儿感染性疾病常见病原菌分布及耐药趋势变化规律。方法对成都市儿童医院2001-2006年住院患儿所分离的2888株病原菌进行分析,试验方法严格按照美国国家临床试验室标准委员会(NCCLS)最新标准进行。结果 (1)2001-2006年分离株中格兰阴性菌占优势(1845株,63.9%),排列在前8位的儿科常见病原菌依次为大肠埃希菌、嗜血杆菌属、肺炎链球菌、肺炎克雷伯菌、金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌和其他非发酵菌。(2)血培养常见病原菌158株,依次为表皮葡萄球菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、其他非发酵菌、肺炎链球菌和铜绿假单胞菌。(3)痰培养常见病原菌2018株,依次为大肠埃希菌、嗜血杆菌属、肺炎链球菌、肺炎克雷伯菌、金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌、其他非发酵菌。(4)泌尿系统病原菌120株,以大肠埃希菌为主,其他依次为肺炎克雷伯菌、其他非发酵菌、铜绿假单胞菌、表皮葡萄球菌。(5)脓培养病原菌497株,依次为大肠埃希菌、金黄色葡萄球菌、表皮葡萄球菌、嗜血杆菌属、其他非发酵菌、肺炎克雷伯菌、肺炎链球菌、铜绿假单胞菌。(6)各种体液(包括胸、腹腔液体和局部穿刺液等)病原菌85株,依次为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、肺炎链球菌和其他非发酵菌。2001-2003年与2004-2006年相比,病原菌排序发生变化,病原菌总体耐药情况呈上升趋势。2001-2003年和2004-2006年耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为6.7%、17.2%;耐甲氧西林凝固酶阴性的葡萄球菌(MRCNS)菌株检出率分别为20%、70.2%;大肠埃希菌和肺炎克雷伯菌的超广谱β内酰胺酶(ESBL_s+)菌株合计检出率分别为21.8%、43.8%;流感嗜血杆菌产β内酰胺酶率分别为19.4%、39.7%。结论近3年成都地区儿科常见致病菌分布发生变化,病原菌总体耐药情况呈上升趋势。开展区域性耐药菌株监测以指导儿科临床合理用药十分必要。
Objective To investigate the distribution of common pathogenic bacteria in pediatric infectious diseases in Chengdu and the changes of drug resistance trend. Methods 2888 isolates from children hospitalized in Chengdu Children’s Hospital from 2001 to 2006 were analyzed. The test methods were strictly in accordance with the latest standards of the National Committee for Clinical Laboratory Standards (NCCLS). Results (1) Dominant gram-negative bacteria (1845, 63.9%) were isolated from 2001 to 2006. The common pediatric pathogens in the top 8 were Escherichia coli, Haemophilus, Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa and other non-fermenting bacteria. (2) A total of 158 blood culture common pathogens, followed by Staphylococcus epidermidis, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, other non-fermentative bacteria, Streptococcus pneumoniae and Pseudomonas aeruginosa. (3) There are 2018 strains of common pathogens in sputum culture, followed by Escherichia coli, Haemophilus, Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, other non-fermentative bacteria. (4) 120 strains of urinary system pathogens, Escherichia coli-based, the other followed by Klebsiella pneumoniae, other non-fermentative bacteria, Pseudomonas aeruginosa, Staphylococcus epidermidis. (5) 497 strains of pathogenic bacteria were cultured in pus, followed by Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, Haemophilus, other non-fermentative bacteria, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonas aeruginosa . (6) A total of 85 pathogenic bacteria, including Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pneumoniae, were collected from various body fluids (including thoracic and peritoneal fluid and local puncture fluid) Other non-fermenting bacteria. Compared with 2004-2006, the sequencing of pathogens changed from 2001 to 2003, and the overall drug resistance of pathogens was on the rise. The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) in 2001-2003 and 2004-2006 were 6.7% and 17.2% respectively. The detection rates of methicillin-resistant coagulase-negative Staphylococcus aureus (MRCNS) were 20% and 70.2% respectively. The total detection rates of ESBL-ES strains of Escherichia coli and Klebsiella pneumoniae were 21.8% and 43.8%, respectively. The percentage of β-lactamases produced by Haemophilus influenzae Respectively, 19.4%, 39.7%. Conclusion The distribution of common pathogenic bacteria in pediatrics in Chengdu area has changed in recent 3 years, and the overall drug resistance of pathogens is on the rise. It is very necessary to carry out the monitoring of regional drug-resistant strains to guide pediatric clinical rational drug use.