541例烧伤感染住院患儿病原菌分布及耐药性分析

戴嘉喜; 李琳; 许乐; 陈昭宏; 李小毅; 刘敏; 温裕庆; 陈晓东

doi:10.3760/cma.j.issn.1009-2587.2016.11.008

541例烧伤感染住院患儿病原菌分布及耐药性分析

doi: 10.3760/cma.j.issn.1009-2587.2016.11.008

1. 350001 福州,福建医科大学附属协和医院烧伤科;
2. 350001 福州,福建医科大学附属协和医院护理部;
3. 解放军第一八〇医院烧伤科;
4. 解放军第九二医院烧伤科;
5. 龙岩市第一医院烧伤科;
6. 福建省烧伤研究所

基金项目:

福建省医学创新课题（2015－CX－20）

国家临床重点专科建设项目（卫办医政函〔2012〕649号、国卫办医函〔2013〕544号）

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出版历程
- 收稿日期: 2016-05-31
- 网络出版日期: 2021-10-28
- 刊出日期: 2016-11-20

Analysis of distribution and drug resistance of pathogens isolated from 541 hospitalized children with burn infection

1. Department of Burns, Fujian Medical University Union Hospital, Fuzhou 350001, China

摘要

摘要: 目的了解烧伤感染住院患儿病原菌分布和耐药性。　方法 2013年1月—2015年12月，福建医科大学附属协和医院、解放军第一八〇医院、解放军第九二医院、龙岩市第一医院共收治541例烧伤感染住院患儿，送检848份临床标本(血液、导管尖端附着物、创面分泌物等)进行病原菌检测。用全自动微生物鉴定仪鉴定菌株；应用K－B纸片扩散法或MIC检测法，选择庆大霉素、氨曲南、红霉素、克林霉素等41种临床常用抗生素进行药物敏感试验。采用SPSS 20.0统计软件，分析不同年度、不同医院、不同标本来源病原菌检出率，革兰阳性菌、革兰阴性菌和真菌分布情况，主要病原菌分布情况，抗甲氧西林葡萄球菌检出情况，常见革兰阳性菌和革兰阴性菌对临床常用抗生素的耐药率。　结果病原菌总检出率为35.14%(298/848)。2013、2014、2015年送检标本病原菌检出率分别为52.29%(114/218)、33.20%(83/250)、26.58%(101/380)。福建医科大学附属协和医院、解放军第一八〇医院、解放军第九二医院、龙岩市第一医院送检的标本中病原菌检出率分别为38.45%(198/515)、51.43%(18/35)、71.70%(38/53)、17.96%(44/245)。创面分泌物、血液、引流液或组织液、其他标本(包括导管尖端附着物、痰液、粪便)病原菌检出比分别为136/261、8/137、3/4、7/48。298株病原菌中，革兰阳性菌159株(53.36%)、革兰阴性菌129株(43.29%)、真菌10株(3.36%)。金黄色葡萄球菌检出率最高，共68株，占22.82%；其次为铜绿假单胞菌、鲍氏不动杆菌、表皮葡萄球菌，分别检出37、31、22株，占12.42%、10.40%、7.38%。金黄色葡萄球菌中抗甲氧西林金黄色葡萄球菌(MRSA)占70.59%(48/68)，表皮葡萄球菌中抗甲氧西林表皮葡萄球菌(MRSE)占68.18%(15/22)。MRSA、MRSE对青霉素、氨苄西林耐药率均为100.0%，MRSA另对红霉素、四环素、克林霉素耐药率较高，MRSE另对红霉素、复方磺胺甲唑耐药率较高；铜绿假单胞菌仅对复方磺胺甲唑耐药率较高，为83.3%；鲍氏不动杆菌对哌拉西林、头孢他啶、复方磺胺甲唑耐药率较高，为58.8%～71.4%。　结论 3年间福建省4家医院烧伤感染住院患儿病原菌检出率差异大，以革兰阳性菌居多，检出率居前4位的为金黄色葡萄球菌、铜绿假单胞菌、鲍氏不动杆菌、表皮葡萄球菌。多数检出菌对临床常用抗生素有不同程度的耐药，尤以MRSA、MRSE、鲍氏不动杆菌耐药率较高。
- 烧伤 /
- 儿童 /
- 细菌 /
- 真菌 /
- 抗药性
Abstract: Objective To investigate the distribution and drug resistance of pathogens isolated from hospitalized children with burn infection. Methods Totally 541 patients were hospitalized in Fujian Medical University Union Hospital, the 180th Hospital of Chinese People′s Liberation Army(PLA), the 92th Hospital of PLA, and Longyan First Hospital from January 2013 to December 2015. Totally 848 clinical specimens (blood, catheter tip attachments, wound exudate, etc.) were collected for pathogen detection. After being identified by an automatic microbiological identification system, drug resistance of pathogens to 41 commonly-used antibiotics in clinic including gentamicin, aztreonam, erythromycin, clindamycin, etc. was tested by K-B paper disk diffusion method or minimal inhibitory concentration detection method. The SPSS 20.0 statistical software was used to analyze the following subjects: the detection rates of pathogens in different years, from different hospitals, and with different sources, the distribution of gram-negative bacteria, gram-positive bacteria, and fungi, the distribution of major pathogens, the detection rate of methicillin-resistant Staphylococcus, the resistant rates of common gram-positive bacteria and gram-negative bacteria to antibiotics. Results The total detection rate of pathogens was 35.14% (298/848). The detection rates of pathogens were 52.29% (114/218), 33.20% (83/250), and 26.58% (101/380) in 2013, 2014, and 2015 respectively, 38.45% (198/515), 51.43% (18/35), 71.70% (38/53), and 17.96% (44/245) from Fujian Medical University Union Hospital, the 180th Hospital of PLA, the 92th Hospital of PLA, and Longyan First Hospital respectively, and 136/261, 8/137, 3/4, and 7/48 from wound exudate, blood, drainage fluid or tissue fluid, and the other specimens (including catheter tip attachments, sputum, feces) respectively. Among the 298 pathogens, 159 (53.36%) strains were gram-positive bacteria, 129 (43.29%) strains were gram-negative bacteria, and 10 (3.36%) strains were fungi. The detection rate of Staphylococcus aureus was the highest, totally 68 strains, accounting for 22.82%, followed by Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus epidermidis, with 37, 31, and 22 strains, accounting for 12.42%, 10.40%, and 7.38% respectively. Among Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) accounted for 70.59% (48/68). Among Staphylococcus epidermidis, methicillin-resistant Staphylococcus epidermidis (MRSE) accounted for 68.18% (15/22). The resistant rates of MRSA and MRSE to penicillin and ampicillin were all 100.0%, and the resistant rates of MRSA to erythromycin, tetracycline, clindamycin and those of MRSE to erythromycin, cotrimoxazole were high. The high resistant rate of Pseudomonas aeruginosa towards antibiotics was detected with cotrimoxazole (83.3%) only. The resistant rates of Acinetobacter baumannii towards piperacillin, ceftazidime, and cotrimoxazole were high (from 58.8% to 71.4%). Conclusions During the three years, there is large difference in the detection rate of pathogens from these four hospitals in Fujian province. The majority of pathogens were Gram-positive bacteria. The four dominant pathogens were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus epidermidis. Most of the pathogens were resistant to antibiotics commonly used in clinic in different degree, especially MRSA, MRSE and Acinetobacter baumannii, which showed high resistance towards antibiotics.
- Burns /
- Child /
- Bacteria /
- Fungi /
- Drug resistance