目的 分析2014-2015年中山市博爱医院儿科重症监护病房感染性疾病病原菌的分布及耐药性。方法 选取2014年3月-2015年11月中山市博爱医院儿科重症监护病房感染性疾病患儿标本906份,分析菌株标本来源、病原菌分布及主要耐药菌对常用抗菌药物的耐药性。结果 菌株标本共906份,主要来自痰液,构成比为52.76%。其中革兰阴性菌342例(37.75%),主要为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌;革兰阳性菌535例(59.05%),主要为人葡萄球菌、金黄色葡萄球菌、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。革兰阴性菌中,大肠埃希菌对氨苄西林、头孢唑啉呈高耐药性,肺炎克雷伯菌对氨苄西林、头孢唑啉耐药性明显较高,但对复方新诺明、环丙沙星、亚胺培南、左旋氧氟沙星均无耐药性,鲍曼不动杆菌对头孢唑啉、呋喃妥因耐药率较其他药物更高,铜绿假单胞菌对氨苄西林、头孢唑啉、呋喃妥因、复方新诺明呈高耐药性;革兰阳性菌中,人葡萄球菌对红霉素、青霉素G耐药性较高,金黄色葡萄球菌对青霉素G的耐药性明显高于其他药物,表皮葡萄球菌则对青霉素G、苯唑西林、红霉素有高度耐药性,溶血葡萄球菌对青霉素G耐药率高达100%。结论 儿科重症监护病房感染性疾病病原菌较为广泛,临床上应根据致病菌株及耐药情况选择针对性抗菌药物,避免抗生素的滥用。

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.