摘要
目的 探讨随年份变迁北京儿童医院血培养检出菌构成比的变化规律 ,以及与患儿年龄、季节等关系 ,并观察近年菌株耐药性。方法 归纳我院 1983～ 1999年间血培养检出菌 6 5 6 9株。1997年前采用葡萄糖肉汤 ,API系统及手工鉴定 ,1997年后用BD血培养仪培养。用API系统和microscan半自动微生物分析仪鉴定细菌种类 ,用microscan检测药敏 ,以美国临床实验室标准化委员会 (NCCLS)判断结果。结果 凝固酶阴性葡萄球菌 (CNS)检出构成比历年居于 5 0 %以上。肠球菌由本世纪 90年代初 4.8%上升到 1999年 15 .7% (屎肠球菌占总数 6 8.8% ,) ,克雷伯菌属由 0 .4%升到1999年 3.1%。肠杆菌属由 0 .1%升为 1.4%。而大肠艾希菌及金黄色葡萄球菌分别由 1983年的8.1%、6 .3%降为近年的 2 .1%、1.6 %。沙门菌由 2 .7%降为 0 .2 %。葡萄球菌产酶率 92 %～ 10 0 % ,耐甲氧西林金葡 (MRSA)占 16 % ,耐甲氧西林CNS(MRCNS)占 6 4.1%。屎肠球菌、粪肠球菌对氨苄西林、青霉素耐药率分别为 83%、86 %和 18%、33% ,HLAR为 6 0 %、40 % ,VRE为 4%、10 %。肠杆菌科菌对亚胺培南、头孢他定、丁胺卡那 ,氨曲南耐药率 5 0 %以下。大肠艾希菌、克雷伯菌中产超广谱 β 内酰胺酶菌株 (ESBL)分别为 6 4.2 %和 88%。结论 (1)
Objective To investigate the changes of bacteria detected from blood culture of pediatric patients in the past 17 years and the relations between the isolated bacterial species and age of the patients and season, and to observe the antimicrobial resistance of these bacteria. Methods Totally 6 569 bacterial isolates were obtained from blood culture in our hospital between 1983 and 1999. Glucose broth and API system were applied for culture and differentiation before 1997 and later on BD blood culture apparatus was used for culture whereas API and microscan for differentiation and antimicrobial resistance determination. Results were interpreted according to NCCLS recommendations. Results Coagulase negative Staphylococci (CNS) accounted for more than 50% every year. Enterococcus increased from 4.8% in early 1990's to 15.9% in 1999 (Enterococcus faecium accounted for 68.8%). Klebsiella increased from 0.4% of 1983 to 3.1% of 1999. Enterobacteriaceae increased from 0.1% to 1.4%. Escherichia coli and Staphylococcus aureus decreased from 8.1% and 6.3% in 1983 to 2.1% and 1.6% in recent years, respectively. Salmonella decreased from 2.7% to 0.2%. Methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase negative staphylococci (MRCNS) accounted for 16% and 64.1% , respectively. The antimicrobial resistance of Enterococcus faecalis to ampicillin, penicillin and vancomycin was 83%, 18% and 4%, whereas resistance of Enterococcus faecium was 86%, 33% and 10%, respectively. High level ampicillin resistant Enterococcus faecalis and faecium accounted for 60% and 40%, respectively. The antimicrobial resistance of Enterobacteriaceae to imipenem, ceftazidime and amikacin was all below 50%. Escherichia coli and Klebsiella that produce the extended spectrum β-lactamase (ESBL) were accounted for 64.2% and 88%, respectively. Conclusions (1) Low virulence conditional bacteria became common in pediatric patients. (2) Gram-positive bacteria, CNS, Enterococcus faecium and complex bacteria were more frequently detected among young children than other groups. (3) Detection rate of some bacteria and the level of antimicrobial resistance in children were higher than those in adults. Medication should follow the result of surveillance of antimicrobial resistance.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2000年第12期750-754,共5页
Chinese Journal of Pediatrics
关键词
培养基
交叉感染
抗药性
微生物
Culture media
Cross infection
Drug resistance,microbial
