899例小儿革兰阳性细菌感染细菌学分类及抗生素耐药性分析.docVIP

899例小儿革兰阳性细菌感染细菌学分类及抗生素耐药性分析 　 作者：李斌，肖曙芳，吴茜，倪林仙，沈谨，黄海林，吕孟兴 【摘要】 目的：探讨五年来昆明地区小儿感染性疾病中革兰阳性细菌学分类，并对细菌耐药情况进行分析，为临床抗生素的合理使用提供客观依据。方法：对我院2002年1月～2006年12月五年间常见感染性疾病住院患儿标本（血液、下呼吸道分泌物、尿液、粪便等）进行细菌培养及鉴定，并对五年间革兰阳性细菌进行细菌学分类及耐药状况分析。结果：（1）共分离出革兰阳性球菌899株，阳性率2.7%。血液标本主要为凝固酶阴性葡萄球菌、肠球菌；呼吸道标本主要为肺炎链球菌；尿液标本主要为肠球菌。（2）凝固酶阴性葡萄球菌对青霉素耐药率为100%，对红霉素耐药率84.3%。耐甲氧西林金黄色葡萄球菌分离率33.3％，耐甲氧西林凝固酶阴性葡萄球菌分离率67.2％。下呼吸道感染中，肺炎链球菌对青霉素及红霉素的耐药率均为100%，对其他临床常用的抗生素耐药率呈上升趋势，未发现万古霉素耐药株。结论：儿童感染性疾病病原革兰阳性菌种类及耐药性在不断发生变化，败血症患儿凝固酶阴性葡萄球菌发病率上升，应高度重视细菌对抗生素的耐药性变迁，特别是要根据临床分离菌株的药敏情况选用敏感抗生素。 【关键词】 儿童；感染；革兰阳性球菌；变迁；耐药性 ［Abstract］ Objective: To explore the grampositive bacterial distribution and drug resistance in pediatric infectious diseases in Kunming district over the past five years, so as to provide an objective basis for clinical use of antibiotics. Methods:We collected and cultured specimens (blood, lower respiratory tract secretions, urine, feces, etc.) among hospitalized children with common infectious diseases from January 2002 to December 2006. Then we identified Grampositive bacterial infections in bacteriology to the classification of positive pathogens on the disk diffusion method for antimicrobial susceptibility testing and analyzed antibiotic resistance. Results:(1) A total of 899 (2.7% positive) Grampositive cocci were isolated. The main positive species of blood samples were coagulasenegative staphylococci and enterococci, etc.; of major respiratory specimens were streptococcus pneumoniae; of urine samples were primarily enterococci bacteria. (2) Coagulasenegative staphylococci resistance rate to penicillin was 100%, to erythromycin was 84.3%. Methicillinresistant Staphylococcus aureus’s separation rate was 33.3%, methicillinresistant coagulasenegative staphylococci’s isolated rate was 67.2%. Among lower respiratory tract infection, Streptococcus pneumoniae’s resistance rates to penicillin and erythromycin were 100%, to other antibiotics commonly used in clinic was rising. We found no vancomycin resistant