| ObjectiveTo analyze the distribution,composition,drug resistance and clinical characteristics of pathogenic bacteria of nosocomial infection in Children's Medical Center of Qilu Hospital of Shandong University from January 2013 to December 2018,so as to provide scientific basis for clinical diagnosis and rational drug use.MethodAll samples were collected from children's medical center of qilu hospital of shandong university from January 2013 to December 2018.Cases and monitoring data of children were retrospectively investigated and analyzed.The pathogenic bacteria isolated from all kinds of body fluids,secretions and pharyngeal swabs collected in clinical practice of hospitalized children in 6 years were counted.The composition,distribution,clinical characteristics and drug resistance of the pathogenic bacteria were analyzed.The gender,age,season,antibiotic use and major diagnoses of the infected children were counted.The collected data were divided into the first three years(January 2013-December 2015)and the last three years(January 2016-December 2018).The general situation,composition,distribution and drug resistance of the main pathogens were compared in detail between the two periods.All data were analyzed by SPSS22.0.At first,factors were tested for normality,statistical descriptions of measurement data that correspond to normal distribution were expressed as mean+ standard deviation.The median of measurement data that didn't meet the normal distribution and interquartile range report were counted.The mean of measurement data was compared between the two groups,and independent sample t test was used.Two tests were used to compare the counting data between periods,with statistical significance of P<0.05.Results1.General situation:From January 2013 to December 2018,49053 children were hospitalized in the Children's Medical Center of Qilu Hospital,Shandong University.A total of 1011 cases were infected and 1041 strains of pathogenic bacteria were isolated.Infants and young children were the most common age groups.Only 3 cases did not use antibiotics.The rate of antibiotics was 99.70%.Compared with the three years before and after the onset,the infection and age distribution of the children had statistical significance,and there was no statistical significance with the gender and onset season of the children.2.Sources of pathogenic bacteria:blood culture was the first,accounting for 27.67%of the total source of pathogenic bacteria,followed by sputum culture,accounting for 24.69%of the total source of pathogenic bacteria,urine culture,accounting for 23.34%of the total source of pathogenic bacteria.These three main sources of pathogenic bacteria,accounting for 75.7%of the total source of pathogenic bacteria.Compared with the previous three years,the proportion of blood culture increased(22.71%:33.13%,P<0.001),sputum.The proportion of culture components decreased(31.5%:17.17%,P<0.001),while the proportion of urine culture components increased(21.8%:25.05%,P=0.215).Blood flow infection was the main cause of infection in children,and showed an upward trend.3.Pathogenic bacteria composition:Gram-negative bacteria were dominant,Gram-negative bacteria:Gram-positive bacteria 1.29:1,fungi in 10 cases.A total of 10 cases(1%)of fungi were detected,mainly Candida albicans.The proportion of Gram-positive bacteria decreased(45.6%:40.61%,P=0.104)and the proportion of Gram-negative bacteria increased(53.48%:58.38%,P=0.112).4.Change of main pathogenic bacteria composition:Comparing the three years before and after,among Gram-positive bacteria,the proportion of Enterococcus faecium increased(9.52%:9.9%,P=0.838),Staphylococcus aureus increased(9.16%:9.3%,P=0,940),but Streptococcus pneumoniae decreased(11.54%:4.44%,P<0.001);in Gram-negative bacteria,the proportion of Escherichia coli decreased(14.84%:14.74%,P=0.968),and in lung.The constituent ratio of Klebsiella pneumoniae increased(8.8%:17.58%,P<0.001),and that of Pseudomonas aeruginosa increased(7.33%:8.48%,P=0.488).5.Distribution of infection sites:Lower respiratory tract infection alone accounted for 25.51%of total infections;Gram-positive bacteria were dominant in central nervous system infections(P=0.001),Gram-positive bacteria were more common in bloodstream infection,skin infection and umbilical infection(P<0.05).6.Change of drug resistance:The resistance rate of Escherichia coli to ampicillin was 92.86%.The resistance rate of Klebsiella pneumoniae to meropenem and imipenem was 40.30%.The resistance rate of Pseudomonas aeruginosa to imipenem was 25.61%.Enterococcus faecium was 100%resistant to penicillin,Staphylococcus aureus was 98.96%resistant to penicillin and ampicillin,85.42%resistant to penicillin,and Streptococcus pneumoniae was 97.65%resistant to penicillin and 23.53%resistant to meropenem.The three main Gram-positive bacteria were highly sensitive to vancomycin and linezolid.In recent three years,the drug resistance rate of Klebsiella pneumoniae to various antimicrobial agents has increased to varying degrees,and that of Pseudomonas aeruginosa to various antimicrobial agents has decreased to varying degrees.The resistance rates of Enterococcus faecium,Streptococcus pneumoniae and Staphylococcus aureus to antibiotics did not increase significantly.Conclusion1.Infants are the most common nosocomial infections among children under 1 year old.Males and females are 1.51:1.Statistics show that the use rate of antibiotics is 99.70%.Respiratory infections occupy the first place.2.In the isolation of pathogenic bacteria,gram-negative bacteria:Gram-negative bacteria 1.29:1.In the past three years,the proportion of Enterococcus faecalis increased,Staphylococcus aureus increased,and Streptococcus pneumoniae decreased.In gram-negative bacteria,the proportion of Escherichia coli decreased,that of Klebsiella pneumoniae increased,and that of Pseudomonas aeruginosa increased.?Gram-positive bacteria were predominant in central nervous system infections(P=0.001).Gram-positive bacteria were more common in bloodstream infections,skin infections and umbilical infections(P<0.05),while Gram-negative bacteria were predominant in mixed infections(P<0.001).3.Blood culture was the first,sputum culture was the second,and urine culture was the third.In recent three years,the rate of blood culture specimens was on the rise(P<0.001),and the rate of sputum culture specimens was on the decline(P<0.001).4.The resistance rate of Klebsiella pneumoniae to various antimicrobial agents increased in varying degrees,while the resistance rate of Pseudomonas aeruginosa to various antimicrobial agents decreased in varying degrees.The resistance rates of Enterococcus faecium,Streptococcus pneumoniae and Staphylococcus aureus to antibiotics did not increase significantly. |
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