住院患儿下呼吸道感染病原菌耐药性分析

Bacterial distribution and resistance in lower respiratory tract infection from hospitalized children

目的了解我院住院患儿下呼吸道感染病原菌构成及耐药性。方法常规方法分离住院患儿下呼吸道分泌物病原菌,采用全自动微生物鉴定及药敏系统Microscan WalkAway40对病原菌进行鉴定及药敏试验。结果 2012年1月1日~2012年12月31日共分离病原菌1014株,其中革兰阴性菌810株(79.9%),革兰阳性菌204株(20.1%)。最常见的细菌依次为肺炎克雷伯菌(25.3%)、大肠埃希菌(18.2%)、铜绿假单胞菌(14.0%)、金黄色葡萄球菌(12.8%)。大肠埃希菌和肺炎克雷伯菌中产ESBLs菌株检出率分别为57.8%和47.1%,对三、四代头孢菌素敏感率在41%~67%。铜绿假单胞菌对亚胺培南耐药率为5.6%,鲍曼不动杆菌对亚胺培南耐药率为13.3%。MRSA检出率为14.6%。结论我院住院患儿下呼吸道感染病原菌以革兰氏阴性杆菌为主,各病原菌对抗菌药物的耐药性不同,建议临床根据药敏结果合理使用抗菌药物。

Objective To investigate the distribution and antibiotic resistance in lower respiratory tract infection from hospitalized children. Methods Clinical bacterial isolates were identified and antibiotic susceptibility test was carried out by Microscan WalkAway40. Results A total of 1014 clinical strains were isolated in 2012, of which Gram negative microorganisms and Gram positive cocci accounted for 79.9%(810) and 20.1%(204).The most predominant bacterial pathogens were Klebsiella pneumoniae(25.3%),Escherichia coli(18.2%),Pseudomonas aeruginosa(14.0%),S taphylococcus aureus(12.8%).The rate of extend spectrum-B-lactamases(ESBLs) production of Escherichia coli and Klebsiella pneumoniae was 57.8% and 47.1% respecfively. The susceptibility rate to the third and fourth cefoin was 41%, respective by 67%. The antimicrobial resistance rate to Imipenem was 5.6% in P.aeruginosa and A.baumanni was 13.3%. The MRSA defection rate was 14.6%. Conclusion Most clinical isolates are mainly Gram-negative bacilli with varied degrees of resistance to commonly used antibiotics. Clinical rational use of antibiotics should be based on drug sensifiviiry test.