[1]王　艳.儿童血流感染病原菌分布及耐药性分析[J].新乡医学院学报,2021,38(6):559-563.[doi:10.7683/xxyxyxb.2021.06.013]
　WANG Yan.Distribution and drug resistance of pathogenic bacteria of children with bloodstream infection[J].Journal of Xinxiang Medical University,2021,38(6):559-563.[doi:10.7683/xxyxyxb.2021.06.013]
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儿童血流感染病原菌分布及耐药性分析
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年6
页码:
559-563
栏目:
临床研究
出版日期:
2021-06-05

文章信息/Info

Title:
Distribution and drug resistance of pathogenic bacteria of children with bloodstream infection
作者:
王　艳
（洛阳东方医院/河南科技大学第三附属医院检验科，河南　洛阳　471003）
Author(s):
WANG Yan
（Department of Laboratory Medicine,Dongfang Hospital of Luoyang/the Third Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,Henan Province,China）
关键词:
儿童; 血流感染; 病原菌; 抗菌药物; 耐药基因
Keywords:
Childbloodstream infectionpathogenantibacterialsresistance gene
分类号:
R446.5
DOI:
10.7683/xxyxyxb.2021.06.013
文献标志码:
A
摘要:
目的　探讨儿童血流感染的病原菌分布及耐药性。 方法　选择2017年1月至2019年12月洛阳东方医院（河南科技大学第三附属医院）儿科病房收治的70例血流感染患儿为研究对象。患儿在使用抗生素前从左右肘正中静脉或贵要静脉采集双套静脉血各1～3 mL注入血培养瓶送检，同1例患者不同部位所分离出的同1菌株只入选第1株。挑取血平板上菌落，采用全自动细菌鉴定/药物敏感分析系统及配套的药敏卡片进行菌株鉴定和药物敏感性试验；采用聚合酶链反应法检测金黄色葡萄球菌耐药基因型。结果　患儿血培养的732份送检标本中分离出70株非重复首次分离菌株，包括17种细菌和1株真菌（未计入构成比），其中革兰阴性菌构成比为31.88%（22/69），革兰阳性菌构成比为68.12% (47/69),其中以金黄色葡萄球菌构成比最高［26.10%(18/69)］。主要革兰阴性菌中，大肠埃希菌对庆大霉素、环丙沙星、复方磺胺甲噁唑、左旋氧氟沙星有较高的耐药率，对哌拉西林/他唑巴坦、头孢他啶、亚胺培南、美罗培南、阿米卡星敏感；肺炎克雷伯菌对氨苄西林/舒巴坦和头孢唑林有较高的耐药率，对亚胺培南、美罗培南、阿米卡星敏感；铜绿假单胞菌对氨曲南有较高的耐药率，对阿米卡星和左旋氧氟沙星敏感。主要革兰阳性菌中，金黄色葡萄球菌对青霉素、红霉素、苯唑西林有较高的耐药率，对万古霉素和利奈唑胺敏感；凝固酶阴性葡萄球菌对青霉素、苯唑西林、红霉素有较高的耐药率，对万古霉素、替考拉宁、利奈唑胺敏感；肺炎链球菌对复方磺胺甲噁唑、红霉素、克林霉素有较高的耐药率，对利福平、万古霉素、利奈唑胺、莫西沙星、左旋氧氟沙星敏感。18株金黄色葡萄球菌中，包括13株耐甲氧西林金黄色葡萄球菌（MRSA）和5株甲氧西林敏感金黄色葡萄球菌（MSSA）；13株MRSA中耐药基因mecA和ermA检出率较高，其中有8株同时检出耐药基因mecA和erm基因(A或C)；5株MSSA中耐药基因 blaZ 和ermC 检出率较高。结论　儿童血流感染最常见病原菌为金黄色葡萄球菌尤其是MRSA，临床医师应重视病原菌的多药耐药性，合理应用抗菌药物。
Abstract:
Objective　To explore the distribution and drug resistance of pathogenic bacteria of children with bloodstream infection.Methods　　Seventy children with bloodstream infections admitted to the Department of Laboratory Medicine,Dongfang Hospital of Luoyang (the Third Affiliated Hospital of Henan University of Science and Technology) from January 2017 to December 2019 were selected as the research objects.Before taking antibiotics,1-3 mL of double sets of venous blood from the left and right median elbow veins or the expensive veins of children was collected and injected into the blood culture bottle for examination.The same strain isolated from different parts of the same patient was only selected the first strain.Picking the colonies on the blood plate,strain identification and drug sensitivity test were performed by the automatic bacterial identification/drug sensitivity analysis system and the supporting drug sensitivity card;the resistant genotype of Staphylococcus aureus was detected by the polymerase chain reaction method.Results　Among the 732 samples submitted for blood culture of the children,70 non-repetitive first-isolated strains were isolated,including 17 bacteria and 1 fungus (not included in the composition ratio),of which the composition ratio of gram-negative bacteria was 31.88% (22/69),the composition ratio of gram-positive bacteria was 68.12% (47/69),and the composition ratio of Staphylococcus aureus was the highest at 26.08% (18/69).Among the main gram-negative bacteria,Escherichia coli had a higher resistance rate to gentamicin,ciprofloxacin,compound trimethoprim and levofloxacin,and was sensitive to piperacillin/tazobactam,ceftazidime,imipenem,meropenem and amikacin;Klebsiella pneumoniae had a higher resistance rate to ampicillin/sulbactam and cefazolin,and was sensitive to imipenem,meropenem and amikacin;Pseudomonas aeruginosa had a higher resistance rate to aztreonam,and was sensitive to amikacin and levofloxacin.Among the main gram-positive bacteria,Staphylococcus aureus had a higher resistance rate to penicillin,erythromycin and oxacillin,and was sensitive to vancomycin and linezolid;coagulase-negative Staphylococci had a higher resistance rate to penicillin,oxacillin and erythromycin,and was sensitive to vancomycin,teicoplanin and linezolid;Streptococcus pneumoniae had a higher resistance rate to compound trimethoprim,erythromycin and linmycin,and was sensitive to rifampicin,vancomycin,linezolid,moxifloxacin and levofloxacin.Among 18 strains of Staphylococcus aureus,there were 13 strains of methicillin-resistant Staphylococcus aureus (MRSA) and 5 strains of methicillin-sensitive Staphylococcus aureus (MSSA);13 strains of MRSA had a higher detection rate of resistance genes of mecA and ermA,of which 8 strains were simultaneously detected the resistance genes mecA and erm gene (A or C);5 strains of MSSA had a higher detection rate of resistance genes of blaZ and ermC.Conclusion　The most common pathogen of children with bloodstream infections is Staphylococcus aureus,especially MRSA.The clinician should pay attention to the multi-drug resistance of pathogenic bacteria and rationally use antibacterial drugs.

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更新日期/Last Update: 2021-06-05