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目的了解河南省地区儿童血培养病原菌的分布及耐药现状,为临床抗菌药物的合理使用提供指导。方法对2012年10月—2015年10月间儿科血培养阳性菌株利用手工实验及珠海迪尔DL-96系统相结合的方法进行细菌鉴定和抗菌药物敏感性试验,部分药敏试验参考K-B纸片扩散法。所有药敏结果参照美国CLSI标准判读,数据转入WHONET软件进行菌种及耐药性分析。结果河南省妇幼保健院儿科3年共采集13 882例血培养,剔除患儿重复分离株共检出阳性菌株1047株,阳性率为7.5%。阳性菌株中革兰阴性菌以肺炎克雷伯菌为最多,64株,占6.1%;革兰阳性菌以表皮葡萄球菌为最多,189株,占18.1%;真菌中以白色念珠菌为最多,25株,占2.4%。药敏结果显示肺炎克雷伯菌对氨苄西林、氨苄西林/舒巴坦、替卡西林/克拉维酸等耐药率较高,对碳青霉烯类药物耐药率较低。表皮葡萄球菌对红霉素、阿奇霉素等耐药率较高,对万古霉素、利奈唑胺耐药率较低。3岁以下儿童血培养阳性率为12.2%,3岁以上血培养阳性率为6.6%,差异具有统计学意义。结论儿童为特殊人群,其血流感染病情较危重,用药较特殊,应充分利用病原菌监测结果进行用药指导及监督管理,以促进抗菌药物的合理使用。
Objective To understand the distribution and drug resistance of blood-borne pathogens in Henan Province and provide guidance for the rational use of clinical anti-bacterial drugs. Methods Bacterial identification and antimicrobial susceptibility testing were performed on the pediatric blood culture positive strains from October 2012 to October 2015 using manual methods and the Zhuhai Deir DL-96 system. Some susceptibility tests were performed on KB disks Diffusion method. All drug susceptibility results with reference to the US CLSI standard interpretation, the data into the WHONET software for species and drug resistance analysis. Results A total of 13 882 blood cultures were collected in Pediatric Department of Maternal and Child Health Hospital of Henan Province in 3 years. A total of 1047 positive isolates were obtained excluding repeat isolates from children with a positive rate of 7.5%. Gram-negative bacteria in the positive strains of Klebsiella pneumoniae is the most, 64 strains, accounting for 6.1%; Gram-positive bacteria to Staphylococcus epidermidis, 189, accounting for 18.1%; Candida albicans in fungi, 25 strains, accounting for 2.4%. Drug susceptibility results showed that Klebsiella pneumoniae had higher rates of resistance to ampicillin, ampicillin / sulbactam, ticarcillin / clavulanic acid and lower resistance rate to carbapenems. Staphylococcus epidermidis erythromycin, azithromycin and other higher rates of resistance to vancomycin, linezolid resistance rate is lower. The blood culture positive rate of children under 3 years old was 12.2%, the positive rate of blood culture over 3 years old was 6.6%, the difference was statistically significant. Conclusions Children are special populations, their bloodstream infections are more serious and their medication is rather special. They should make full use of the monitoring results of pathogens to guide and supervise the administration of drugs so as to promote the rational use of antibacterial drugs.