【摘要】 目的了解脓毒血症患儿细菌病原菌构成及耐药状况的变迁。方法回顾性分析2002年至2011年连续10年监测的脓毒血症患儿血培养阳性病原菌的构成比及耐药性。结果 2002—2011年68 419份血培养标本中检出2493株病原菌,检出率3.64%。革兰阳性菌株(G+菌)1913株(76.73%),革兰阴性杆菌(G–菌)562株(22.54%),真菌18株(0.72%)。2002—2006年20 287例患儿中血培养阳性959例(4.73%),G+菌731株(76.23%),G–菌228株(23.77%);2007—2011年48 132例患儿中血培养阳性1 534例(3.19%),G+菌1 182株(77.05%),G–菌334株(21.77%),真菌18株(1.17%)。前后5年的血培养阳性率,G+菌、G–菌和真菌的检出分布的差异均有统计学意义(P<0.01),G+菌检出率有增高趋势,G–菌检出率有下降趋势。前后5年以及不同年龄组脓毒症患儿的病原菌分布差异均有统计学意义(P<0.01),以凝固酶阴性葡萄球菌为主;前后5年比较,凝固酶阴性葡萄球菌、克雷伯氏菌、产碱杆菌、真菌的阳性率有增高趋势,而金黄色葡萄球菌、肠球菌、假单孢菌属、沙门氏菌阳性率有降低趋势。10年间G+菌对青霉素、红霉素呈现高度耐药,未发现万古霉素耐药菌株;大肠埃希菌ESBLs阳性菌株、克雷伯菌ESBLs阳性及阴性菌株对抗生素均呈现高度耐药;沙门菌对常用抗生素敏感性较高。结论 10年间儿童脓毒血症主要病原菌以凝固酶阴性葡萄球菌为主,病原菌对常用抗生素耐药率呈逐年增高趋势。更多还原

【Abstract】 Objective To determine the pathogenic bacteria distribution and drug resistance in children with sepsis. Methods From 2002 to 2011, a ten consecutive years of monitoring of pathogenic bacteria distribution, drug resistance in pediatric patients with sepsis were conducted. Results From 2002 to 2011, 2 493 strains of pathogenic bacteria were detected in 68 419 specimens of blood culture. The positive rate was 3.64%. Among them, 1 913 strains(76.73%) were the gram-positive bacteria(G+ bacteria), 562 strains(22.54%) were gram- negative bacteria(G- bacteria) and 18 strains(0.72%) were fungi. From 2002 to 2006, 959 strains(4.73%) of pathogenic bacteria were detected in 20 287 specimens of blood culture. Among them, the G+ bacteria was 731 strains(76.23%), G- bacteria was 228 strains(23.77%). From 2007 to 2011, 1 534 strains(4.73%) of pathogenic bacteria were detected in 48 132 specimens of blood culture, G+ bacteria was 1 182 strains(77.05%), G- bacteria was 334 strains(21.77%), fungi was 18 strains(1.17%). The positive rate of blood culture, the pathogenic bacteria distributions of G+, G-, and fungi were significantly different between the first and the second 5 years(P<0.01). The positive rate of G+ bacteria tended to increase and the positive rate of G- bacteria tended to decrease. Comparing between the first and second 5 years, the positive rate of coagulase-negative staphylococci, Klebsiella, Alcaligenes, fungi tended to increas, and the positive rate of Staphylococcus aureus, Enterococcus, Pseudomonas, Salmonella tended to decrease. The distribution of pathogens in different age groups of children with sepsis also were significantly difference(P<0.001). Over the 10 years, G+ positive bacteria were highly resistant to penicillin and erythromycin, but not resistant to Vancomycin. ESBLs positive E. coli strains and Klebsiella Trevisan became highly resistant to antibiotics. Salmonella was sensitive to commonly used antibiotics. Conclusions Coagulase negative staphylococcus was the most common pathogenic bacteria in children with sepsis in the last 10 years, multiple pathogenic bacteria also show a growing trend in drug resistance.更多还原