2023-我院儿童患者临床分离病原菌分布及耐药性分析.docxVIP

? ? 2014－我院儿童患者临床分离病原菌分布及耐药性分析 ? ? 温晓峥 苏惠婷 崔亚利 摘 要 目的：為儿科临床合理应用抗菌药物提供参考。方法：收集四川大学华西广安医院（以下简称“我院”）2014年1月-2019年6月门诊及住院儿童患者的临床分离菌株，回顾性分析病原菌分布及耐药情况。结果：2014-2019年，我院儿童患者共检出病原菌4 692株，占临床分离病原菌总数的29.56%;主要来源于痰液（3 749株，占79.90%）、血液（203株，占4.33%）、分泌物（137株，占2.92%）等标本。其中，革兰氏阳性菌1 488株（占31.71%），以肺炎链球菌（711株，占15.15%）和金黄色葡萄球菌（574株，占12.23%）为主;革兰氏阴性菌3 204株（占68.29%），以流感嗜血杆菌（2 466株，占52.56%）为主。共检出耐甲氧西林金黄色葡萄球菌172株，产β-内酰胺酶流感嗜血杆菌1 517株，检出率分别为29.97%、61.52%。流感嗜血杆菌对氨苄西林、头孢克洛、头孢呋辛的耐药率均高于50%，且总体呈上升趋势;对头孢噻肟、利福平、氧氟沙星的耐药率均小于6%。肺炎链球菌对红霉素和四环素的耐药率均超过70%，且对红霉素的耐药率呈逐年上升趋势;对β-内酰胺类和喹诺酮类抗菌药物的耐药率普遍低于20%;未见利奈唑胺、万古霉素耐药菌株。金黄色葡萄球菌对青霉素G的耐药率超过90%，对氨基糖苷类、大环内酯类、四环素类相对敏感，未见呋喃妥因、利奈唑胺、万古霉素耐药菌株。结论：我院儿童患者临床分离病原菌以革兰氏阴性菌为主，且以流感嗜血杆菌、肺炎链球菌等苛氧菌居多;耐药、产酶菌株的检出率较高，部分病原菌对常用抗菌药物的耐药率有逐年上升的趋势，耐药形式严峻。临床应实时监测病原菌的耐药情况，并进一步规范儿科抗菌药物的应用，以延缓耐药菌的出现和传播。 Key 儿童患者;细菌耐药监测;流感嗜血杆菌;肺炎链球菌;金黄色葡萄球菌 ABSTRACT? ?OBJECTIVE： To provide reference for rational use of antibiotics in pediatric department. METHODS： Clinical bacterial strains isolated from children outpatients and inpatients were collected from West China Guangan Hospital of Sichuan University （called “our hospital” for short） during Jan. 2014 to Jun. 2019. Distribution and drug resistance of bacteria were analyzed retrospectively. RESULTS： During 2014-2019， total of 4 692 strains were detected， accounting for 29.56% of total; those were mainly from sputum （3 749 strains， 79.90%）， blood （203 strains， 4.33%） and secretion （137 strains， 2.92%） specimen. Among them， 1 488 strains of Gram-positive bacteria （31.71%） were mainly Streptococcus pneumoniae （711 strains， 15.15%） and Staphylococcus aureus （574 strains， 12.23%）; 3 204 strains of Gram-negative bacteria （68.29%） were mainly 2 466 strains of Haemophilus influenza （52.56%）. Totally 172 strains of methicillin-resistant S. aureus and 1 517 strains of β-lactamase producing H. influenzae were detected; the detection rates were 29.97% and 61.52%， respectively. Resistance rates of H. influenza to ampicillin， cefaclor and cefuroxime were higher t