儿童重症监护病房获得性肺炎病原菌分布及耐药性分析

摘要

目的 回顾性分析儿童重症监护病房(PICU)获得性肺炎(HAP)病原菌分布及耐药情况,为临床合理选用抗菌药物提供依据.方法 采用VITEK-32微生物全自动鉴定系统鉴定细菌到种,以纸片扩散法进行药敏试验.结果 共诊断HAP 147例,分离出病原菌274株,革兰阴性(G-)杆菌占78.47%,真菌占12.04%,革兰阳性(G+)球菌占9.49%.鲍曼不动杆菌居首位,大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶(ESBLs)检出率分别为57.69%和59.18%.耐甲氧西林凝固酶阴性葡萄球菌检出率为72.73%.药敏结果显示,G-杆菌均存在不同程度耐药,其中鲍曼不动杆菌和嗜麦芽寡养单胞菌对碳青霉烯类耐药率分别高达74.29%和100%;G+球菌对青霉素类耐药率达81.82%以上;真菌普遍敏感.结论 HAP优势病原菌为G-杆菌.各类细菌对常用抗菌药物表现为严重耐药和多重耐药.不同病原菌对抗生素的敏感性和耐药性差异较大,临床应依据细菌病原学及耐药性资料,合理选择抗菌药物.%Objective To analyze the distribution and drug resistance of pathogenic bacteria causing hospital acquired pneumonia (HAP) in pediatric intensive care unit (PICU) for providing a reasonable basis for the clinical use of antibiotics. Methods The species of bacteria were identified by VITEK-32 automicroscan, ad the antimicrobial susceptibility testing was performed by the disk-diffusion method, respectively. Results Two hundreds and seventyfour strains of bacteria were isolated from the pediatric patients with HAP between January 2007 and May 2009, and consisting of 78.47％ for Gram-negative bacilli (G-), 12.04％ for fungi and 9.49％ for Gram-positive cocci (G+). A cinetobacter baummannii was the most predominant strain in all species of bacteria. The prevalence of extended-spectrum betalactamase (ESBLs) in Escherichia coli and Klebsilla spp was 57.69％ and 59.18％ respectively. There was 72.73％ of coagulase negative Stophylococcus with the rcsistant to methicillin (MRCNS). Antibiotic susceptibility tests showed that the multidrug resistanees of G- bacteria to antibiotics were serious. The rate of drug resistance to earbopenems was up to 74.89％ in Acinetobaccter boummannii and 100％ in Stenotrophomonas moltophilia, respectively. G+ bacteria had severe drug resistance to penicillin (81.82％), and the fungi remained sensitive to antifungal agents. Conclusions The main pathogens causing HAP are G- bacteria. The various bacteria are serious resistance to common antimicrobial agents and usually with the different sensitivities to the same antimicrobial agents. The antibiotics should be selected reasonably according to the antibiotic sensitivity test.