Bacteria Distribution Characteristics And Drug Resistance Analysis Of A Single Pediatric Intensive Care Unit

Objective To analyze the characteristics of the bacteria distribution and drug resistance in PICU,then provide evidence for clinical application of antibiotics reasonably.At the same time,the risk factors of common multidrug-resistant organisms infection were analyzed in order to guide the prevention and control of drug-resistant organisms.Methods The retrospective study was conducted from January 1,2013 to December 31,2017 in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.The results of pathogenic bacteria culture and drug sensitivity in PICU were analyzed,and the characteristics of common bacteria distribution,drug resistance and risk factors of common multi-drug resistant bacteria infection in PICU were statistically analyzed.Results 1.The bacteria distribution : A total of 779 nonrepeating bacteria were isolated from 14101 samples,including 529 gram-negative bacteria(67.9%)and 250 gram-positive bacteria(32.1%).The mainly pathogens were 129 strains of Klebsiella pneumoniae(16.6%),110 strains of Acinetobacter spp(14.1%),93 strains of Staphylococcus aureus(11.9%),66 strains of Escherichia coli(8.5%),57 strains of Streptococcus pneumoniae(7.3%),etc.Sputum culture,catheter tip culture and skin secretion culture were dominated by gram-negative bacteria,while blood culture,urine culture and cerebrospinal fluid culture were dominated by gram-positive bacteria.Klebsiella pneumoniae and Escherichia coli infection mainly occurred in infants,while Staphylococcus aureus and Streptococcus pneumoniae infection showed high detection rate in older children.As the duration of hospitalization increased,the detection rate of gram-negative bacteria increased,while gram-positive bacteria bacteria decreased.The detection rate of major multiple-drug resistant organisms increased from 2013 to 2015,and plummeted in 2016.2.Bacterial resistance: The detection rates of ESBLs produced by Escherichia coli and Klebsiella were 57.6% and 68.1%,respectively.The drug resistance rates of ampicillin,piperacillin and cefazolin were extremely high,all exceeding 70%.Escherichia coli is sensitive to carbapenem antibiotics,and the drug resistance rate is 4.5%-6.1%,but Klebsiella's is as high as 40%.Acinetobacter baumannii showed multiple drug resistance and was only slightly sensitive to tetracycline.Pseudomonas aeruginosa had low r esistance to aminoglycosides and quinolones.The drug resistance rate of Haemophilus influenzae to ampicillin and compound sulfamethoxazole was higher than 50%.The drug resistance rate of staphylococcus to penicillin and erythromycin was extremely high,but the sensitivity to tekola,vancomycin and linezolid was 100%.The incidence of MRSA was 44.1%.Streptococcus pneumoniae resistance rate to erythromycin and clindamycin is up to 90%,and is extremely sensitive to quinolones.3.Risk factor analysis of bacterial drug resistance: use of third generation of cephalosporins or above antibiotics before the hospital over three days,the invasive procedures in the hospital and the the length of PICU stay(from admission to pathogen detection)over one week,are the independent risk factor for the main multiple-drug resistant organisms infection.Conclusion 1.In PICU of our hospital,The overall positive rate of microbial culture is not high,and the common bacteria were mainly gram-negative bacteria.2.The distribution of pathogenic bacteria was different among different specimens,ages,hospitalization days and years.So we should be targeted in the clinical empirical drug use.3.The drug resistance of bacteria in PICU of our hospital increased with the extension of the application time of PICU.But after strict hospital infection control,the rate has decreased significantly,indicating that standardized management is an important means to reduce the infection of drug-resistant bacteria in hospital.4.The proportion of multi-drug resistant bacteria in PICU of our hospital is relatively high,and the drug sensitivity has its own characteristics,which has a great guiding effect on the early clinical experience drug use.5.Independent risk factors for major drug-resistant bacterial infections include: use of third generation of cephalosporins or above antibiotics before the hospital over three days,the invasive procedures in the hospital and the the length of PICU stay(from admission to pathogen detection)over one week.In view of the risk factors,early prevention should be taken to reduce the occurrence of drug-resistant bacteria.