| Objective A retrospective analysis of the distribution characteristics of gramnegative bacteria in the pediatric intensive care unit of Ningbo Women and Children’s hospital from January 2012 to December 2017 and the current situation and trend of drug resistance of antibiotics in clinical use were discussed,aiming to provide a scientific basis for guiding the rational use of antimicrobial agents and controlling bacterial resistance.Methods Collect all kinds of specimens of children in the pediatric intensive care unit of our hospital from January 2012 to December 2017.The specimens are mainly from sputum,blood,amniotic fluid,urine,feces,pus,wound,cerebrospinal fluid,venous catheter,etc.The isolation culture is preliminarily carried out,and then the biochemical tests such as touch enzyme,oxidase and plasma coagulation enzyme are carried out.Strictly in accordance with the Clinical and Laboratory Standard Institute(CLSI)recommended operation method,according to the clinical commonly used antimicrobial agents to choose appropriate drug sensitive piece of paper,use the K-B disc diffusion method for drug sensitive test(hereinafter referred to as drug susceptibility test).The quality control strains are klebsiella pneumoniae(ATCC700603),escherichia coli(ATCC25922)and pseudomonas aeruginosa(ATCC27853),which are provided by the ministry of health’s biological products.Refer to the guidelines recommended by the clinical laboratory standardization committee(CLSI)for 2012-2017,collect the relevant clinical data of children with bacterial strain and using EXCEL to summarize all data.Bacterial composition is expressed as percentage(%),and drug sensitivity is indicated by drug resistance rate(%).All data are analyzed using SPSS18.0 software,and chi-square test is used.P < 0.05 indicates that the difference is statistically significant.Results 1.A total of 2453 pathogenic bacteria are detected for 6 years,with 1331 strains of gram-negative bacteria accounting for 54.26%.The first four of the bacteria are klebsiella pneumoniae(310 strains,23.29%),escherichia coli(270 strains,20.29%),acinetobacter baumannii(180 strains,13.52%),and enterobacter cloacae(131,9.84%).The ratio of bacteria to pathogenic bacteria is higher from 2015 to 2017 than that from 2012 to 2014,and the difference is statistically significant(2=73.198,P=0.000 < 0.05).Klebsiella species(klebsiella pneumoniae,producing acid klebsiella bacillus)and e.coli account for a increasing trend(P < 0.05),haemophilus influenzae and deputy flu bloodthirsty bacillus account for a downward trend.2.G-bacteria are mainly derived from respiratory secretions,including lower respiratory tract(1018 strains,76.48%)and upper respiratory tract(89,6.69%).The sex ratio for children infected with g-bacteria is male: female =1.59:1;There are more male children infected than female children every year,and the ratio of male and female is decreased,that the difference is statistically significant(χ2=5.105,P=0.024 < 0.05).3.A total of 259 strains of ESBLs are detected.There are 104 strains of klebsiella pneumoniae,and the positive rate is 33.55%.Along with 153 strains of ESBLs escherichia coli,with a positive rate of 56.67%,which is significantly higher than ESBLs klebsiella pneumoniae.Klebsiella pneumoniae infection in summer and autumn is more frequent than winter and spring,and the difference is statistically significant(P < 0.05).There is no significant difference between the distribution of escherichia coli and the seasonal statistics(P ﹥0.05).4.Klebsiella pneumoniae has an upward trend in the drug resistance rate of ampicillin,ampicillin/sulbactam,amtrazine,ceftriaxone and cefazolin(P < 0.05).While the drug resistance rate of the compound sinomin and nitrofurantoin is decreased(P < 0.05).The intestinal escherichia coli is 50% higher than that of penicillin,aminotrium,cephalosporin,three generations cephalosporin,fourth-generation cephalosporin,and compound new norming resistance.And the resistance of most antimicrobial drug is higher than klebsiella pneumoniae.The resisitance of G-bacteria is less than 10% for quinolones,aminoglycoside antibiotics,carbapenem drugs and piperacillin/tazobactam.The annual drug resistance rate of G-bacteria is 0,37.5%,28.6%,57.1%,50%,and 75%,respectively,and the total number of cefuroxime resistance is increased from chart 4.G-bacteria shows a decreasing trend in the drug resistance of compound xinnol,that the difference is statistically significant(P < 0.05).The resistance of G-bacteria to ceftriaxone is higher than that of cephalosporin,that the difference is statistically significant(P < 0.05).Conclusions 1.Our hospital pediatric intensive care unit in 2012-2017 gram negative bacteria detection rate is on the rise,the klebsiella species(klebsiella bacillus klebsiella pneumoniae and produced acid)and e.coli account for ascend rise,haemophilus influenzae and deputy flu bloodthirsty bacillus accounted for decrease rise.2.There are more male children infected than female children,and the top four were klebsiella pneumoniae,escherichia coli,acinetobacter baumannii and enterobacter cloacae.3.Infect of children by Klebsiella pneumoniae often happens in summer and autumn;There is no obvious seasonal distribution of escherichia coli infection.4.E.coli and klebsiella pneumoniae have no significant changes in antimicrobial resistance to piperazilin/sulbactam,ceftazole,cefepime and carbapenem.The drug resistance of cephalosporins and beta-lactase inhibitors is higher than klebsiella pneumoniae.Klebsiella pneumoniae has an upward trend in ceftriaxone resistance.5.The antimicrobial agents of piperacillin/sulbatartan and carbapenem have highly effective against gram-negative bacteria.The resistance of G-bacteria to ceftriaxone is higher than cephalosporin. |
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