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三级护理医院儿科病房疑似败血症儿童血培养分离株中的微生物模式及抗生素敏感性

Microbial Patterns and Antibiotic Susceptibility in Blood Culture Isolates of Septicemia Suspected Children in the Pediatrics Ward of a Tertiary Care Hospital.

作者信息

Khan Muhammad Sarfraz, Kareem Arslan, Fatima Kiran, Rauf Saima, Khalid Areeb, Bashir Muhammad Shaheryar

机构信息

Rawalpindi Medical University, Rawalpindi, Pakistan.

Department of Pathology, Rawalpindi Medical University, Rawalpindi, Pakistan.

出版信息

J Lab Physicians. 2021 Mar;13(1):64-69. doi: 10.1055/s-0041-1726271. Epub 2021 May 13.

Abstract

This study aims to determine microbial patterns and antibiotic susceptibility to alert clinicians to the emerging pathogens that may pose a threat to the community, especially children.  This retrospective cross-sectional study was conducted in the Department of Pathology, Holy Family Hospital, Rawalpindi, Pakistan, from July 2019 to December 2019. Two samples were taken from two different sites of each patient at the time of fever (> 100° F) to avoid chances of contamination. A blood sample of 5 to 10 mL was drawn from each site. In a 50 mL brain heart infusion broth (BHIB), 5 to 10% blood was injected in two different bottles and incubated for 48 hours at 37°C. After 48 hours, subculture was done by streaking the drops of blood samples taken from BHIB on blood and MacConkey agar. Cultures were incubated in aerobic conditions at 37°C for 24 to 48 hours. For testing antibiotic susceptibility, criteria defined by the Clinical and Laboratory Standards Institute (CLSI) were followed. Microbes were identified under a microscope by observing their morphological characteristics after gram staining and applying biochemical tests. Antibiotic sensitivity test was performed using standard aseptic methods.  Bacterial isolates and their susceptibility patterns were represented using frequencies and percentage charts.  Out of 423 blood cultures, growth was recorded in 92 (21.75%) of the cultures with female to male ratio 2.1:1. The gram-positive bacteria accounted for 43.48% ( = 40), whereas gram-negative bacteria covered the majority 54.36% ( = 50). Among isolates, (42.39%) was the most common, followed by (17.39%) and (14.13%). showed 0% susceptibility to amikacin and cefotaxime. All the isolates were 100% resistant to amoxicillin-clavulanic acid. showed lower sensitivity for ceftazidime (0%), clindamycin (66.67%), ciprofloxacin (0%), clarithromycin (11.76%), and ceftriaxone (0%). Tigecycline showed 100% sensitivity for all isolates tested.  Gram-negative bacteria form the majority of isolates in our setup, with as the most common species among them. The resistance against cephalosporins, penicillin, and fluoroquinolones shown by , , and is of grave concern. Among gram-positive bacteria, has established resistance against multiple drugs. Limited and objective use of antibiotic therapy is a much-needed strategy under new guidelines.

摘要

本研究旨在确定微生物模式及抗生素敏感性,以提醒临床医生注意可能对社区尤其是儿童构成威胁的新出现病原体。

这项回顾性横断面研究于2019年7月至2019年12月在巴基斯坦拉瓦尔品第圣家医院病理科进行。在患者发热(>100°F)时从每个患者的两个不同部位采集两份样本,以避免污染。从每个部位抽取5至10 mL血液样本。在50 mL脑心浸液肉汤(BHIB)中,将5%至10%的血液注入两个不同的瓶子中,并在37°C下孵育48小时。48小时后,通过将从BHIB采集的血样滴在血琼脂和麦康凯琼脂上划线进行传代培养。培养物在37°C有氧条件下孵育24至48小时。为测试抗生素敏感性,遵循临床和实验室标准协会(CLSI)定义的标准。通过革兰氏染色后观察微生物的形态特征并进行生化试验,在显微镜下鉴定微生物。使用标准无菌方法进行抗生素敏感性试验。

细菌分离株及其敏感性模式用频率和百分比图表表示。

在423份血培养物中,92份(21.75%)培养物有细菌生长,女性与男性比例为2.1:1。革兰氏阳性菌占43.48%(n = 40),而革兰氏阴性菌占多数,为54.36%(n = 50)。在分离株中,大肠埃希菌(42.39%)最为常见,其次是肺炎克雷伯菌(17.39%)和金黄色葡萄球菌(14.13%)。大肠埃希菌对阿米卡星和头孢噻肟的敏感性为0%。所有分离株对阿莫西林 - 克拉维酸均100%耐药。肺炎克雷伯菌对头孢他啶(0%)、克林霉素(66.67%)、环丙沙星(0%)、克拉霉素(11.76%)和头孢曲松(0%)的敏感性较低。替加环素对所有测试分离株的敏感性为100%。

在我们的研究中,革兰氏阴性菌是分离株中的大多数,其中大肠埃希菌是最常见的菌种。大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌和铜绿假单胞菌对头孢菌素、青霉素和氟喹诺酮类药物的耐药性令人严重担忧。在革兰氏阳性菌中,金黄色葡萄球菌已对多种药物产生耐药性。在新指南下,有限且有针对性地使用抗生素治疗是一项急需的策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1fc/8154347/4e2c9f066000/10-1055-s-0041-1726271_08_0325_01.jpg

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