重庆地区小儿肺炎细菌耐药性及抗生素应用分析

Common pathogens, their drug resistance and clinical application of antibiotics in children with pneu-monia in Chongqing

目的 分析重庆地区小儿肺炎常见病原菌构成及其耐药性,探讨临床抗生素的合理应用。方法 吸取1 165例小儿肺炎下呼吸道分泌物,利用microscan全自动微生物分析仪进行细菌鉴定、培养及药敏试验,并统计临床初始抗生素应用情况。结果 细菌总分离数为392株(33.7％),其中革兰阴性菌257株(65.6％),前5位依次为肺炎克雷伯菌、流感嗜血杆菌、副流感嗜血杆菌、铜绿假单胞菌及大肠埃希菌;革兰阳性细菌为135株(34.4％),依次为肺炎链球菌、金黄色葡萄球菌、表皮葡萄球菌。药物敏感实验显示:铜绿假单胞菌与葡萄球菌呈多重耐药,其它细菌对抗生素敏感性差异较大,较敏感的有头孢呋辛、头孢曲松等;而泰能、阿米卡星、万古霉素则高度敏感。1 165例小儿肺炎使用抗生素种类达21种,使用率100％。单用一种者占38.5％,联合二种者占61.5％;无一例首选万古霉素或泰能。初始抗生素治愈率为76.7％(894/1 165例),好转率为18.5％(216/1 165例)。结论 重庆地区小儿肺炎病原菌以革兰阴性菌占优势,不同细菌对抗生素敏感性差异较大;临床多选用二、三代头孢菌素。积极监测细菌耐药性,有助于提供选择抗生素的依据,对提高疗效和避免耐药菌株的快速增长有重要意义。

Objective To investigate common pathogens, their drug resistance and clinical application of antibiotics in children with pneumonia in Chongqing. Methods Bacteria identification and antibiotics sensitivity test were performed in samples of lower respiratory tract secretions from 1 165 cases by microscan automatic analysis machine. Results Total number of isolated bacteria were 392 strains (33.7%), predominantly Gram negative bacteria, orderly Klebsiella pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Pseudomonas aeruginosa and Escherichia colt. There were 135 strains (34.4% ) of Gram positive bacteria, in order Streptococcus pneumoniae, Staphylococcus aureus, and Staphylococcus epiderrmdis. Antibiotics sensitivity test showed that Pseudomonas aeruginosa and Staphylococcus expressed multiple resistance, others were heterogenic in antibiotics sensitivity, usually intermediate to cefuroxime and ceftriaxone, while highly sensitive to imipenem, amikacin and vancomycm. More than 21 kinds of antibiotics had been used in 1 165 cases of pneumonia. About 38.5% patients were treated by one kind of antibiotics while combination regimens with two or more antibiotics were employed in 61 .5% patients. Imipenem and vancomycin had never been used in initial therapy. The overall cure rate was 76.7%, while 18.5% patients improved markedly.Conclusions In Chongqing, children's pneumonia is mainly caused by Gram negative bacteria. The sensitivity of antibiotics is different in different bacteria. In clinic, second or third-generation ccphalosporins are common options. Drug resistance monitoring has high impact on antibiotics selection to improve the therapeutic efficacy and prevent rapid growing of resistant strains.