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目的了解山东大学齐鲁儿童医院病原菌分布及耐药情况,指导临床合理使用抗菌药物,减少耐药菌株的产生。方法对2014年1~12月的临床送检样本进行病原菌鉴定及耐药监测。采用微生物鉴定分析仪进行鉴定,K-B纸片扩散法进行药敏试验,根据CLSI 2010年标准判定耐药结果。结果 2014年1~12月山东大学齐鲁儿童医院共送检临床样本33 887份,病原菌检出2 813份,检出率8.30%。革兰阴性菌1 982株,占73.60%,主要是肺炎克雷伯菌(486株)、大肠埃希菌(456株)、非发酵阴性杆菌(449株,主要包括铜绿假单胞菌196株、嗜麦芽假单胞菌113株、鲍曼不动杆菌100株);革兰阳性菌714株,占25.38%,其中葡萄球菌属523株,链球菌129株,肠球菌62株。占前10位的细菌依次为肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、阴沟肠杆菌、铜绿假单胞菌、肺炎链球菌、嗜麦芽假单胞菌、鲍曼/溶血不动杆菌、表皮葡萄球菌、弗劳氏枸橼酸杆菌,所占比例为17.28%(486株)、16.21%(456株)、12.16%(342株)、10.24%(288株)、6.97%(196株)、4.41%(124株)、4.02%(113株)、5.05%(100株)、3.31%(93株)、2.31%(65株)。共检出真菌117株,其中白色念珠菌105株,占3.73%。季也蒙念珠菌3株,近平滑念珠菌8株,热带念珠菌1株。结论儿童病原菌以革兰阴性杆菌为主,且多数革兰阴性菌对碳青霉烯类药物较敏感,对其它药物具有一定的耐药性,鲍曼复合不动杆菌感染具有增长趋势,且耐药性也在增加;革兰阳性球菌对万古霉素敏感性较高。
Objective To understand the distribution and drug resistance of pathogens in Qilu Children’s Hospital of Shandong University, to guide the rational use of antibacterials in clinic and to reduce the production of drug-resistant strains. Methods The clinical samples from January to December 2014 were tested for pathogen identification and drug resistance. Microbiological identification analyzer was used to identify, K-B disk diffusion method for susceptibility testing, according to CLSI 2010 criteria to determine the drug resistance. Results From January to December 2014, 33 887 clinical samples were sent to Qilu Children’s Hospital of Shandong University, and 2 813 pathogens were detected, the detection rate was 8.30%. 1 982 Gram-negative bacteria accounted for 73.60%, mainly Klebsiella pneumoniae (486 strains), Escherichia coli (456 strains), non-fermentative negative bacteria (449 strains, mainly including Pseudomonas aeruginosa 196 strains , 113 strains of Pseudomonas maltophilia and 100 strains of Acinetobacter baumannii); 714 strains of Gram-positive bacteria (accounting for 25.38%), including Staphylococcus 523, Streptococcus 129 and Enterococcus 62. The top 10 bacteria were Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Enterobacter cloacae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Pseudomonas maltophilia, Bowman / hemolysis Acinetobacter, Staphylococcus epidermidis and Citrobacter freundii, accounting for 17.28% (486), 16.21% (456), 12.16% (342), 10.24% (288) and 6.97% 196 strains), 4.41% (124 strains), 4.02% (113 strains), 5.05% (100 strains), 3.31% (93 strains) and 2.31% (65 strains). A total of 117 fungi were detected, of which 105 were C. albicans, accounting for 3.73%. Quarter also Candida 3, nearly 8 Candida parapsilosis, Candida tropicalis 1 strain. Conclusions Gram-negative bacilli are the most common pathogens in children, and most Gram-negative bacteria are more susceptible to carbapenems and have some drug resistance to other drugs. Acinetobacter baumannii infection has an increasing trend and is resistant to Drug resistance is also increasing; Gram-positive cocci is more susceptible to vancomycin.