基于PIC数据库重症监护病房患儿血培养检出病原菌及耐药性

Distribution and drug resistance of pathogens from blood culture of children in intensive care unit based on PIC database

  • 摘要:
    目的 分析儿科重症监护病房(PICU)患儿血流感染病原菌分布与耐药性, 为临床经验性抗感染治疗提供指导。
    方法 基于儿科重症监护数据库(PIC, http://pic.nbscn.org), 利用R软件, 回顾性分析2010-2019年浙江大学医学院附属儿童医院PICU患儿的病原学资料, 探讨血流感染病原菌种类、分布及耐药性情况。
    结果 共分离出病原菌991株, 其中革兰阳性菌727株(73.36%)、革兰阴性菌213株(21.49%)和真菌51株(5.15%)。革兰阳性菌以表皮葡萄球菌(320株, 32.29%)为主, 其次为人葡萄球菌(118株, 11.91%)、头状葡萄球菌(55株, 5.55%)和屎肠球菌(D群, 33株, 3.33%)。革兰阴性菌主要为肺炎克雷伯菌(59株, 5.95%)、大肠埃希菌(58株, 5.85%)、鲍曼不动杆菌(25株, 2.52%)和铜绿假单胞菌(18株, 1.82%)。耐药性分析显示, 革兰阳性菌对β内酰胺类普遍耐药, 对万古霉素和利奈唑胺仍保持敏感; 革兰阴性菌耐药率较高, 尤其是鲍曼不动杆菌和铜绿假单胞菌, 呈现多重耐药特性。
    结论 PICU患儿血流感染以革兰阳性菌为主, 经验治疗应结合病原菌分布及耐药数据, 选用敏感药物以优化治疗方案。

     

    Abstract:
    OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from the children with bloodstream infection in pediatric intensive care unit (PICU) so as to provide guidance for empirical clinical treatment of infections.
    METHODS Based on the Pediatric Intensive Care Database (PIC, http://pic.nbscn.org), the etiological data were collected from the PICU children of Children′ s Hospital, Zhejiang University School of Medicine by R software in 2010-2019 and were retrospectively analyzed. The species, distribution and drug resistance of the pathogens isolated from the children were observed.
    RESULTS Totally 991 strains of pathogens were isolated, 727 (73.36%) of which were gram-positive bacteria, 213 (21.49%) were gram-negative bacteria, and 51 (5.15%) were fungi. Staphylococcus epidermidis (320 strains, 32.29%) was the predominant species of the gram-positive bacteria, followed by Staphylococcus hominis(118 strains, 11.91%), Staphylococcus capitis (55 strains, 5.55%) and Enterococcus faecium (Group D, 33 strains, 3.33%); Klebsiella pneumoniae (59 strains, 5.95%), Escherichia coli (58 strains, 5.85%), Acinetobacter baumannii (25 strains, 2.52%) and Pseudomonas aeruginosa (18 strains, 1.82%) were the major species of gram-negative bacteria. The analysis of drug resistance showed that the gram-positive bacteria were generally resistant to β lactams and maintained sensitive to vancomycin and linezolid; the gram-negative bacteria showed high drug resistance rates, especially, A. baumannii and P. aeruginosa, showed multi-drug resistance.
    CONCLUSIONS The gram-positive bacteria are dominant among the pathogens isolated from the PICU children with bloodstream infections. The empirical treatment should be performed based on the distribution and drug resistance data of the pathogens, and sensitive drugs should be chosen for optimization of the treatment regimen.

     

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