巴基斯坦三级医院小儿血流感染的细菌谱和抗菌谱

doi:10.24920/003675

Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (4): 315-322.doi: 10.24920/003675

巴基斯坦三级医院小儿血流感染的细菌谱和抗菌谱

Anees Muhammad^1,⁴,Sadiq Noor Khan¹,Tahir Jamal²,Irshad Ul Haq³,Abdul Jabbar¹,Ihsan Ali^5,^*()

¹哈里浦大学基础与应用科学学院医学实验室技术系，哈里普，22620巴基斯坦
²雷曼医学研究所，白沙瓦，22620巴基斯坦
³哈里浦大学基础与应用科学学院微生物学系，哈里浦，22620巴基斯坦
⁴巴查汗医学院医学技术学院,马丹，23200 巴基斯坦
⁵开伯尔医科大学附属医学科学研究所，白沙瓦，22620 巴基斯坦

收稿日期:2019-10-29 接受日期:2020-04-30 出版日期:2020-12-31 发布日期:2020-10-28
通讯作者: Ihsan Ali E-mail:ihsanmicro@gmail.com

Bacterial Spectrum and Antimicrobial Profile of Pediatric Blood Stream Infection at a Tertiary Care Hospital in Pakistan

Anees Muhammad^1,⁴,Sadiq Noor Khan¹,Tahir Jamal²,Irshad Ul Haq³,Abdul Jabbar¹,Ihsan Ali^5,^*()

¹Department of Medical Laboratory Technology, University of Haripur, Haripur, Khyber Pathtunkhwa (KPK) 22620, Pakistan
²Rehman Medical Institute (RMI), Peshawar, KPK 22620, Pakistan
³Department of Microbiology, University of Haripur, Haripur, KPK 22620, Pakistan
⁴College of Medical Technology, Bacha Khan Medical College, Mardan, KPK 23200, Pakistan
⁵Institute of Paramedical Sciences, Khyber Medical University, Peshawar, KPK 22620, Pakistan

Received:2019-10-29 Accepted:2020-04-30 Published:2020-12-31 Online:2020-10-28
Contact: Ihsan Ali E-mail:ihsanmicro@gmail.com

1. Supplementary table S1.pdf(140KB)

摘要/Abstract

摘要：

目的血流感染（blood stream infection, BSI）是全球范围儿童发病和死亡的主要原因之一。本研究旨在确定BSI的流行程度,重点是鉴定BSI的病原体,并进一步评估致病细菌病原体的抗生素敏感性。
方法于2018年1月至12月在巴基斯坦白沙瓦的三级医院进行横断面研究。血液样本采集于在BACTECTM瓶中,采用标准的微生物学方法对细菌菌株进行分离和鉴定。依据临床实验室标准化协会（Clinical Laboratory Standard Institute, CLSI）2014年指南,使用圆盘扩散法进行抗生素敏感性测试。
结果共进行567次血液培养,其中BSI阳性111例（19.6％）。在阳性血培养中,男童占64％（71/111）,女童占36％（40/111）。微生物的致病优势菌群为革兰氏阴性菌79株（71.1％）,革兰氏阳性菌32株（28.9％）。分离株的常见细菌是伤寒沙门氏菌（n=35,31.5％）,大肠杆菌（n=19,17.1％）,金黄色葡萄球菌（n=18,16.2％）,肺炎克雷伯菌（n=12,10.8％）,及肠球菌（n=7,6.3％）。有36.7％（29/79）的革兰氏阴性菌分离株是超广谱β-内酰胺酶（ESBL）产生者。61.1％（11/18）的金黄色葡萄球菌菌株对甲氧西林耐药。总体而言,72.9％的分离株具有多重耐药性。
结论革兰氏阴性菌是儿童血流感染的主要病因,伤寒沙门氏菌是主要的致病菌,而大多数伤寒沙门氏菌分离株对环丙沙星耐药。

关键词: 抗生素耐药性, 血流感染, 儿科, 巴基斯坦

Abstract:

Objectives Blood stream infections (BSIs) are the main cause of morbidity and mortality in children worldwide. The present study was carried out to determine the prevalence of BSI with a focus on the identification of the causative agent of BSI, and to further evaluate the antibiotic susceptibility profile of the causing bacterial pathogens.
Methods A cross-section study was carried out at the tertiary care hospital in Peshawar, Pakistan from January to December, 2018. Blood samples were collected in BACTEC^TM bottles and standard microbiological protocols were applied for the isolation and identification of bacterial strains. The antibiotic susceptibility tests were performed using disc diffusion method as per the 2014 guideline of Clinical Laboratory Standard Institute (CLSI).
Results Of 567 blood cultures in total, 111(19.6%) were positive for BSI. Male children were 64 % (71/111) and female children were 36% (40/111). For the causative predominant group of microorganisms, Gram-negative bacteria were identified in 79 (71.1%) isolates, and Gram-positive bacteria in 32 (28.9%) isolates. The common bacteria of isolates were S. typhi (n=35, 31.5%), E. coli (n=19, 17.1%), S. aureus (n=18, 16.2%), K. pneumonia (n=12, 10.8%), and Enterococcus species (n=7, 6.3%). The 36.7% (29/79) isolates of Gram-negative bacteria were ESBL producers, and 61.1% (11/18) of S. aureus isolates were methicillin resistant. Overall, 72.9% isolates were multidrug resistant.
Conclusions Gram-negative bacteria were the main cause of pediatric BSIs, where the predominant microorganism was S. typhi. Remarkably, majority of the S. typhi isolates were resistant to ciprofloxacin.

Key words: antibiotic resistance, blood stream infections, pediatric, Pakistan

Anees Muhammad, Sadiq Noor Khan, Tahir Jamal, Irshad Ul Haq, Abdul Jabbar, Ihsan Ali. Bacterial Spectrum and Antimicrobial Profile of Pediatric Blood Stream Infection at a Tertiary Care Hospital in Pakistan[J].Chinese Medical Sciences Journal, 2020, 35(4): 315-322.

图/表 4

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Bacterial isolates	n	%
Gram-positive isolates	32	28.8
Methicillin resistant Staphylococcus aureus (MRSA)	11	9.9
Staphylococcus aureus	7	6.3
Enterococcus spp	7	6.3
Streptococcus spp	6	5.4
Coagulase negative Staphylococcus spp (CONS)	1	0.9
Gram-negative isolates	79	71.2
Salmonella typhi	35	31.5
Escherichia coli	19	17.1
Klebsiella pneumonia	12	10.8
Pseudomonas aeruginosa	6	5.5
Salmonella paratyphi	4	3.6
Enterobacter aeruginosa	2	1.8
Citrobacter spp	1	0.9

Bacteria	Ampi- cillin	Aztreo- nam	Azithromycin	Amikacin	Chloramphenicol	Ciproflo- xacin	Co-Trimo- xazole	Ceftria- xone	Cefota- xime	Ceftazidime	Imipenam	Cefepime	Colistin/Polymyxin B	Tazocin	Gentamicin
S. typhi (n=35)	11 (31.4)	11 (31.4)	10 (28.6)	NT	11 (31.4)	27 (77.1)	11 (31.4)	0 (0)	6 (17.1)	NT	1 (2.9)	6 (17.1)	NT	8 (22.9)	NT
S. paratyphi (n=4)	0 (0)	1 (25)	0 (0)	NT	0 (0)	2 (50)	0 (0)	0 (0)	NT	NT	NT	3 (25)	NT	3 (75)	NT
P.aeruginosa (n=6)	NT	2 (33.3)	NT	0	NT	1 (16.7)	NT	2 (33.3)	2 (33.3)	2 (33.3)	5 (83.3)	2 (33.3)	NT	0 (0)	2 (33.3)
K.pneumonia (n=12)	12 (100)	12 (100)	NT	9 (75)	NT	8 (66.7)	7 (58.3)	12 (100)	12 (100)	11 (92.7)	7 (58.3)	12 (100)	1 (8.3)	3 (25)	7 (58.3)
Enterobacter spp (n=2)	2 (100)	2 (100)	NT	0	NT	1 (50)	2 (100)	2 (100)	1 (50)	1 (50)	0 (0)	2 (100)	0 (0)	1(50)	2 (100)
Citrobacter spp (n=1)	NT	1 (100)	NT	0	NT	0 (0)	1 (100)	1 (100)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
E. coli (n=19)	NT	15 (78.9)	NT	0	11 (13.9)	5 (73.3)	13 (68.4)	13 (68.4)	NT	13 (68.4)	1 (5.3)	NT	NT	3 (15.8)	3 (15.8)
Total (n=79)	25 (31.6)	44 (55.6)	10 (12.6)	9 (11.3)	22 (27.8)	44 (55.6)	34 (43.0)	30 (37.9)	21 (26.5)	27 (34.1)	14 (17.7)	25 (31.6)	1 (1.3)	18 (22.7)	14 (17.7)

Bacteria*	Amikacin	Ampicillin/clavulanic acid	Ampicillin	Cefepime	Cefotaxime		Ceftriaxone		Cefoxitin	Chloramphenicol		Ciproflo- xacin		Clarith- romycin		Clindamycin		Co-Tria- moxazole
Staphylococcus aureus
MRSA (n=11)	6 (54.5)	9 (81.8)	10 (90.9)	11 (100)	NT		NT		11 (100)	2 (18.2)		9 (81.8)		5 (45.6)		4 (36.4)		5 (45.6)
MSSA (n=7)	0 (0)	6 (85.7)	6 (85.7)	NT	NT		NT		0 (0)	1 (14.3)		5 (71.4)		NT		0 (0)		4 (57.1)
Streptococcus spp (n=6)	NT	NT	5 (83.3)	6 (100)	3 (50)		3 (50)		NT	0(0)		0 (0)		4 (66.7)		3 (50)		NT
Enterococcus spp (n=7)	NT	NT	7 (100)	NT	NT		NT		NT	5 (71.4)		6 (85.7)		5 (71.4)		NT		NT
Total (n=31)	6 (19.3)	15 (48.4)	28 (90.3)	6 (100)	3 (9.6)		3 (9.6)		11 (35.5)	8 (25.8)		20 (64.5)		14 (45.2)		7 (22.6)		9 (29.0)
Bacteria*	Doxycycline	Erythromycin	Gentamicin	Levofloxacin		Linezolid		Meropenem	Minocycline		Penicillin		Rifampicin		Teicoplanin		Vancomycin
Staphylococcus aureus
MRSA (n=11)	5 (45.6)	9 (81.8)	7 (63.6)	8 (72.2)		0 (0)		NT	6 (54.5)		10 (90.9)		2 (18.2)		NT		0 (0)
MSSA (n=7)	0 (0)	3 (42.9)	0 (0)	NT		0 (0)		NT	0 (0)		7 (100)		0 (0)		NT		0 (0)
Streptococcus spp (n=6)	4 (66.7)	4 (66.7)	2 (33.3)	4 (66.7)		0 (0)		6 (100)	0 (0)		3 (50)		3 (50)		0 (0)		0 (0)
Enterococcus spp (n=7)	NT	6 (85.7)	4 (57.1)	NT		0 (0)		NT	1 (14.3)		3 (42.9)		7 (100)		1 (14.3)		0 (0)
Total (n=31)	9 (29.0)	22 (70.9)	13 (41.9)	12 (38.7)		0 (0)		6 (100)	7 (22.6)		23 (74.2)		12 (37.7)		1 (3.2)		0 (0)

Bacterial	Isolates	Number of antibiotics being resistant to
Bacterial	Isolates	1	2	3	4	>4
S. typhi	35 (31.5)	18 (51.4)	13 (37.1)	3 (8.6)	1 (2.9)	0 (0)
E. coli	19 (17.1)	4 (21.1)	7 (36.8)	4 (21.1)	4 (21.1)	0 (0)
S. aureus	19 (17.1)	2 (10.5)	1 (5.3)	3 (15.8)	4 (21.1)	9 (47.4)
K. pneumonia	12 (10.8)	0 (0)	2 (16.6)	2 (16.7)	0 (0)	8 (66.7)
P. aeruginosa	6 (5.4)	2 (33.3)	2 (33.3)	1 (16.6)	1 (16.6)	0 (0)
Enterococcus spp.	7 (6.3)	1 (16.6)	2 (33.3)	0 (0)	0 (0)	4 (66.7)
Streptococcus spp.	6 (5.4)	0 (0)	0 (0)	2 (33.3)	3 (50.0)	1 (16.6)
S. paratyphi	4 (3.6)	2 (50.0)	2 (50.0)	0 (0)	0 (0)	0 (0)
Enterobacter spp.	2 (1.8)	0 (0)	0 (0)	1 (50.0)	0 (0)	1 (50.0)
Citrobacter spp.	1 (0.9)	0 (0)	1 (100)	0 (0)	0 (0)	0 (0)
Total	111 (100)	29 (26.1)	30 (27.0)	16 (14.4)	13 (11.7)	23 (20.7)

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巴基斯坦三级医院小儿血流感染的细菌谱和抗菌谱

Bacterial Spectrum and Antimicrobial Profile of Pediatric Blood Stream Infection at a Tertiary Care Hospital in Pakistan

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