目的 分析武汉大学人民医院儿童血流感染病原菌特征及耐药性分析。方法 选取2018年1月—2021年12月武汉大学人民医院患儿血培养标本分离的病原菌及其药物敏感性数据进行统计分析。结果 共收集到21 571份住院儿童的血培养标本，共分离出病原菌1 646株，检测阳性率为7.63%。其中革兰阳性菌910株，占比为55.29%，革兰阴性菌715株，占比43.44%，真菌21株，占比1.28%。儿童血流感染前5位的病原菌依次为肺炎克雷伯菌、表皮葡萄球菌、肺炎链球菌、人葡萄球菌和大肠埃希菌，占比分别为20.60%、15.25%、14.52%、10.69%、10.57%。耐甲氧西林的凝固酶阴性葡萄球菌（MRCNS）检出率为20.47%，未发现有万古霉素耐药的凝固酶阴性葡萄球菌。肺炎克雷伯菌产超广谱β-内酰胺酶（ESBL）阳性占比为74.93%，大肠埃希菌ESBL阳性占比为6.90%；耐碳青霉烯酶的肠杆菌目（CRE）大肠埃希菌占比为56.32%，CRE肺炎克雷伯菌占比为0%。肺炎链球菌对红霉素、克林霉素、四环素耐药率较高，分别为100.0%、92.9%、85.2%，未发现对莫西沙星、利奈唑胺以及万古霉素耐药菌株。结论 武汉大学人民医院儿童血流感染主要菌株为肺炎克雷伯菌、肺炎链球菌和凝固酶阴性葡萄球菌（CNS），且CNS耐药性较高，肺炎克雷伯菌对第3代头孢有了较高耐药性。应加强医院儿童耐药菌株监测，合理使用抗菌药物。

Objective To analyze the characteristics and drug resistance of pathogenic bacteria of children bloodstream infection in Renmin Hospital of Wuhan University. Methods The data of pathogenic bacteria and drug sensitivity isolated from blood culture samples of children in Renmin Hospital of Wuhan University from January 2018 to December 2021 were selected for statistical analysis. Results A total of 21 571 blood samples from hospitalized children were collected, and 1 646 strains of pathogenic bacteria were isolated, with a positive rate of 7.63%. Among them, 910 gram-positive strains accounted for 55.29%, 715 gram-negative strains accounted for 43.44%, and 21 fungal strains accounted for 1.28%. The top 5 pathogenic bacteria of children bloodstream infection were Klebsiella pneumoniae, Staphylococcus epidermidis, Streptococcus pneumoniae, Staphylococcus hominis and Escherichia coli, accounting for 20.60%, 15.25%, 14.52%, 10.69%, and 10.57%, respectively. The detection rate of methicillin-resistant coagulase negative staphylococcus (MRCNS) was 20.47%, and no coagulase negative staphylococcus resistant to vancomycin was found. The ESBL positive rate of Klebsiella pneumoniae was 74.93%, ESBL positive rate of Escherichia coli was 6.90%. Carbapenemase-resistant Enterobacteriaceae (CRE) Escherichia coli accounted for 56.32%, CRE Klebsiella pneumoniae accounted for 0%. The drug resistance rates of Streptococcus pneumoniae to erythromycin, clindamycin and tetracycline were 100.0%, 92.9%, and 85.2%, respectively. No drug resistance strains to moxifloxacin, linezolid and vancomycin were found. Conclusion The main blood stream infection strains of children in Renmin Hospital of Wuhan University were Klebsiella pneumoniae, Streptococcus pneumoniae and coagulase negative staphylococcus (CNS), with high drug resistance of CNS, and Klebsiella pneumoniae had high drug resistance to the third generation cephalosporin. It is necessary to strengthen the monitoring of drug-resistant strains in hospital children and rationally use antibiotics.

R978.1

湖北省卫生厅科研项目（JX6B23）；赤壁市重点科技计划项目（2019SF001）