目的 分析武漢大學(xué)人民醫(yī)院兒童血流感染病原菌特征及耐藥性分析。方法 選取2018年1月—2021年12月武漢大學(xué)人民醫(yī)院患兒血培養(yǎng)標(biāo)本分離的病原菌及其藥物敏感性數(shù)據(jù)進(jìn)行統(tǒng)計分析。結(jié)果 共收集到21 571份住院兒童的血培養(yǎng)標(biāo)本，共分離出病原菌1 646株，檢測陽性率為7.63%。其中革蘭陽性菌910株，占比為55.29%，革蘭陰性菌715株，占比43.44%，真菌21株，占比1.28%。兒童血流感染前5位的病原菌依次為肺炎克雷伯菌、表皮葡萄球菌、肺炎鏈球菌、人葡萄球菌和大腸埃希菌，占比分別為20.60%、15.25%、14.52%、10.69%、10.57%。耐甲氧西林的凝固酶陰性葡萄球菌（MRCNS）檢出率為20.47%，未發(fā)現(xiàn)有萬古霉素耐藥的凝固酶陰性葡萄球菌。肺炎克雷伯菌產(chǎn)超廣譜β-內(nèi)酰胺酶（ESBL）陽性占比為74.93%，大腸埃希菌ESBL陽性占比為6.90%；耐碳青霉烯酶的腸桿菌目（CRE）大腸埃希菌占比為56.32%，CRE肺炎克雷伯菌占比為0%。肺炎鏈球菌對紅霉素、克林霉素、四環(huán)素耐藥率較高，分別為100.0%、92.9%、85.2%，未發(fā)現(xiàn)對莫西沙星、利奈唑胺以及萬古霉素耐藥菌株。結(jié)論 武漢大學(xué)人民醫(yī)院兒童血流感染主要菌株為肺炎克雷伯菌、肺炎鏈球菌和凝固酶陰性葡萄球菌（CNS），且CNS耐藥性較高，肺炎克雷伯菌對第3代頭孢有了較高耐藥性。應(yīng)加強醫(yī)院兒童耐藥菌株監(jiān)測，合理使用抗菌藥物。

Objective To analyze the characteristics and drug resistance of pathogenic bacteria of children bloodstream infection in Renmin Hospital of Wuhan University. Methods The data of pathogenic bacteria and drug sensitivity isolated from blood culture samples of children in Renmin Hospital of Wuhan University from January 2018 to December 2021 were selected for statistical analysis. Results A total of 21 571 blood samples from hospitalized children were collected, and 1 646 strains of pathogenic bacteria were isolated, with a positive rate of 7.63%. Among them, 910 gram-positive strains accounted for 55.29%, 715 gram-negative strains accounted for 43.44%, and 21 fungal strains accounted for 1.28%. The top 5 pathogenic bacteria of children bloodstream infection were Klebsiella pneumoniae, Staphylococcus epidermidis, Streptococcus pneumoniae, Staphylococcus hominis and Escherichia coli, accounting for 20.60%, 15.25%, 14.52%, 10.69%, and 10.57%, respectively. The detection rate of methicillin-resistant coagulase negative staphylococcus (MRCNS) was 20.47%, and no coagulase negative staphylococcus resistant to vancomycin was found. The ESBL positive rate of Klebsiella pneumoniae was 74.93%, ESBL positive rate of Escherichia coli was 6.90%. Carbapenemase-resistant Enterobacteriaceae (CRE) Escherichia coli accounted for 56.32%, CRE Klebsiella pneumoniae accounted for 0%. The drug resistance rates of Streptococcus pneumoniae to erythromycin, clindamycin and tetracycline were 100.0%, 92.9%, and 85.2%, respectively. No drug resistance strains to moxifloxacin, linezolid and vancomycin were found. Conclusion The main blood stream infection strains of children in Renmin Hospital of Wuhan University were Klebsiella pneumoniae, Streptococcus pneumoniae and coagulase negative staphylococcus (CNS), with high drug resistance of CNS, and Klebsiella pneumoniae had high drug resistance to the third generation cephalosporin. It is necessary to strengthen the monitoring of drug-resistant strains in hospital children and rationally use antibiotics.

R978.1

湖北省衛(wèi)生廳科研項目（JX6B23）；赤壁市重點科技計劃項目（2019SF001）