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目的分析儿科重症监护病房(PICU)常见革兰阴性(G~-)菌的分布特点及其对常用抗菌药物的耐药性情况,为合理使用抗生素提供参考。方法回顾性分析重庆医科大学附属儿童医院重症医学科2013年1月至2015年2月临床分离的213株G~-菌进行耐药性分析。结果经培养共分离出的213株G~-菌,以呼吸道来源为主,占64.8%。常见G~-菌为铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、阴沟肠杆菌、嗜麦芽黄单胞菌。药敏结果显示细菌耐药性明显增强,阴沟肠杆菌、大肠埃希菌、肺炎克雷伯菌肺炎亚种对美洛培南、亚胺培南敏感率为100.0%,对环丙沙星、左旋氧氟沙星、阿米卡星敏感性在70.3%以上;超广谱β-内酰胺酶(ESBLs)菌株检出率在76.7%以上。铜绿假单胞菌仅对环丙沙星、左旋氧氟沙星、庆大霉素、阿米卡星、多粘菌素敏高度感度,敏感度在87.0%以上。鲍曼不动杆菌对美洛培南、亚胺培南、环丙沙星、左旋氧氟沙星、庆大霉素、阿米卡星、头孢吡肟、头孢他啶相对敏感,敏感度在53.3%~73.3%;ESBLs检出率为76.7%。嗜麦芽黄单胞菌仅对左旋氧氟沙星、环丙沙星、复方新诺明相对敏感,敏感度在53.3%~73.3%,对美洛培南、亚胺培南100.0%耐药。结论 G~-菌耐药日趋严重,多为多重耐药。为避免耐药率上升,临床应合理使用抗生素。
Objective To analyze the distribution of common Gram - negative bacteria in pediatric intensive care unit (PICU) and its resistance to commonly used antibiotics, so as to provide a reference for the rational use of antibiotics. Methods Retrospective analysis of drug resistance of 213 strains of G ~ - bacteria isolated from the Department of Critical Care Medicine, Children’s Hospital Affiliated to Chongqing Medical University from January 2013 to February 2015. Results A total of 213 strains of G ~ - bacteria isolated from the culture were mainly respiratory origin, accounting for 64.8%. Common G ~ - bacteria Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter cloacae, Xylotrophomonas maltophilia. The drug susceptibility results showed that the drug resistance of bacteria was significantly enhanced. The susceptibilities of Enterobacter cloacae, Escherichia coli and Klebsiella pneumoniae pneumonia to meropenem and imipenem were 100.0% Levofloxacin and amikacin were more than 70.3%. The detection rate of extended-spectrum β-lactamase (ESBLs) strains was over 76.7%. Pseudomonas aeruginosa only ciprofloxacin, levofloxacin, gentamicin, amikacin, polymyxin sensitive high sensitivity, the sensitivity of more than 87.0%. Acinetobacter baumannii is relatively sensitive to meropenem, imipenem, ciprofloxacin, levofloxacin, gentamycin, amikacin, cefepime, ceftazidime with a sensitivity of 53.3% ~ 73.3%; the detection rate of ESBLs was 76.7%. Xanthomonas maltophilia was only sensitive to levofloxacin, ciprofloxacin and cotrimoxazole, the sensitivity was 53.3% ~ 73.3%, and was resistant to meropenem and imipenem 100.0%. Conclusion G ~ - resistant bacteria is becoming more and more serious, mostly multi-drug resistant. In order to avoid the rise of drug resistance, antibiotics should be used rationally in clinic.