目的 分析2014-2015年中山市博愛醫(yī)院兒科重癥監(jiān)護病房感染性疾病病原菌的分布及耐藥性。方法 選取2014年3月-2015年11月中山市博愛醫(yī)院兒科重癥監(jiān)護病房感染性疾病患兒標本906份,分析菌株標本來源、病原菌分布及主要耐藥菌對常用抗菌藥物的耐藥性。結(jié)果 菌株標本共906份,主要來自痰液,構(gòu)成比為52.76%。其中革蘭陰性菌342例(37.75%),主要為大腸埃希菌、肺炎克雷伯菌、鮑曼不動桿菌、銅綠假單胞菌;革蘭陽性菌535例(59.05%),主要為人葡萄球菌、金黃色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌;真菌29例(3.20%),其中白色念珠菌24例。革蘭陰性菌中,大腸埃希菌對氨芐西林、頭孢唑啉呈高耐藥性,肺炎克雷伯菌對氨芐西林、頭孢唑啉耐藥性明顯較高,但對復方新諾明、環(huán)丙沙星、亞胺培南、左旋氧氟沙星均無耐藥性,鮑曼不動桿菌對頭孢唑啉、呋喃妥因耐藥率較其他藥物更高,銅綠假單胞菌對氨芐西林、頭孢唑啉、呋喃妥因、復方新諾明呈高耐藥性;革蘭陽性菌中,人葡萄球菌對紅霉素、青霉素G耐藥性較高,金黃色葡萄球菌對青霉素G的耐藥性明顯高于其他藥物,表皮葡萄球菌則對青霉素G、苯唑西林、紅霉素有高度耐藥性,溶血葡萄球菌對青霉素G耐藥率高達100%。結(jié)論 兒科重癥監(jiān)護病房感染性疾病病原菌較為廣泛,臨床上應(yīng)根據(jù)致病菌株及耐藥情況選擇針對性抗菌藥物,避免抗生素的濫用。

Objective To analyze the distribution and drug resistance of pathogens in pediatric intensive care unit (PICU) of Boai Hospital of Zhongshan during 2014-2015. Methods Samples (906 cases) were selected from PICU of Boai Hospital of Zhongshan from March 2014 to November 2015. Specimen source, pathogen distribution, and drug resistance of pathogens to common antibiotics were analyzed. Results A total of 906 strains of pathogens were isolated. The pathogenic bacteria (52.76%) were isolated mainly from sputum samples. Gram-negative bacteria (342 strains) accounted for 37.75%, main of them were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Gram-positive bacteria were 535 cases (59.05%), main of them were Staphylococcus hominis, S. aureus, S. epidermidis, and S. haemolyticus. Fungus was 29 cases (3.20%), in which Candida albicans were 24 cases. In Gram-negative bacteria, E. coli had serious resistance against ampicillin and cefazolin. K. pneumoniaewas resistant to ampicillin and cefazolin, while there was no resistant to cotrimoxazole, ciprofloxacin, imipenem, and levofloxacin. A. baumanniihad higher resistance against cefazolin and macrodantin than other antibiotics. P. aeruginosawas resistant to ampicillin, cefazolin, macrodantin, and cotrimoxazole. In Gram-positive bacteria, S. hominiswas resistant to erythrocin and penicillin G. S. aureushad higher resistance against penicillin G than other antibiotics. S. epidermidishad serious resistance against penicillin G, oxacillin, and erythrocin. The drug resistance rate of S. haemolyticus against penicillin G was 100.00%. Conclusion The infectious pathogens of PICU are more widely, they should be selected according to the drug resistance of pathogens in clinic, and to avoid the overuse of antibiotics.