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[541例烧伤感染住院患儿病原菌分布及耐药性分析]

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

作者信息

Dai J X, Li L, Xu L, Chen Z H, Li X Y, Liu M, Wen Y Q, Chen X D

机构信息

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

出版信息

Zhonghua Shao Shang Za Zhi. 2016 Nov 20;32(11):670-675. doi: 10.3760/cma.j.issn.1009-2587.2016.11.008.

Abstract

To investigate the distribution and drug resistance of pathogens isolated from hospitalized children with burn infection. 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 the resistant rates of common gram-positive bacteria and gram-negative bacteria to antibiotics. 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 was the highest, totally 68 strains, accounting for 22.82%, followed by with 37, 31, and 22 strains, accounting for 12.42%, 10.40%, and 7.38% respectively. Among methicillin-resistant (MRSA) accounted for 70.59% (48/68). Among methicillin-resistant (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 towards antibiotics was detected with cotrimoxazole (83.3%) only. The resistant rates of towards piperacillin, ceftazidime, and cotrimoxazole were high (from 58.8% to 71.4%). 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 . Most of the pathogens were resistant to antibiotics commonly used in clinic in different degree, especially MRSA, MRSE and which showed high resistance towards antibiotics.

摘要

调查烧伤感染住院儿童分离病原菌的分布及耐药情况。2013年1月至2015年12月,福建医科大学附属协和医院、解放军第180医院、解放军第92医院和龙岩市第一医院共收治541例患儿。共采集848份临床标本(血液、导管尖端附着物、伤口渗出液等)进行病原菌检测。经自动微生物鉴定系统鉴定后,采用K-B纸片扩散法或最低抑菌浓度检测法检测病原菌对庆大霉素、氨曲南、红霉素、克林霉素等41种临床常用抗生素的耐药性。采用SPSS 20.0统计软件分析不同年份、不同医院、不同来源病原菌的检出率,革兰阴性菌、革兰阳性菌和真菌的分布,主要病原菌的分布,耐甲氧西林金黄色葡萄球菌的检出率,常见革兰阳性菌和革兰阴性菌对抗生素的耐药率。病原菌总检出率为35.14%(298/848)。2013年、2014年和2015年病原菌检出率分别为52.29%(114/218)、33.20%(83/250)和26.58%(101/380),福建医科大学附属协和医院、解放军第180医院、解放军第92医院和龙岩市第一医院的检出率分别为38.45%(198/515)、51.43%(18/35)、71.70%(38/53)和17.96%(44/245),伤口渗出液、血液、引流液或组织液及其他标本(包括导管尖端附着物、痰液、粪便)的检出率分别为136/261、8/137、3/4和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%,其次是凝固酶阴性葡萄球菌、大肠埃希菌和肺炎克雷伯菌,分别为37株、31株和22株,占12.42%、10.40%和7.38%。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)占70.59%(48/68)。凝固酶阴性葡萄球菌中耐甲氧西林表皮葡萄球菌(MRSE)占68.18%(15/22)。MRSA和MRSE对青霉素和氨苄西林的耐药率均为100.0%,MRSA对红霉素、四环素、克林霉素及MRSE对红霉素、复方新诺明的耐药率较高。仅检测到阴沟肠杆菌对复方新诺明耐药率较高(83.3%)。肺炎克雷伯菌对哌拉西林、头孢他啶和复方新诺明的耐药率较高(58.8%~71.4%)。三年间,福建省这四家医院病原菌检出率差异较大。病原菌以革兰阳性菌为主。四种主要病原菌为金黄色葡萄球菌、凝固酶阴性葡萄球菌、大肠埃希菌和肺炎克雷伯菌。多数病原菌对临床常用抗生素有不同程度耐药,尤其是MRSA、MRSE和阴沟肠杆菌对抗生素耐药性较高。

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