重庆地区儿童社区获得性肺炎病原体及细菌药敏分析

Etiology and antimicrobial resistance of children with communityacquired pneumonia in Chongqing area

目的:探讨重庆地区儿童社区获得性肺炎病原体构成和细菌耐药情况。方法:对572例社区获得性肺炎患儿进行痰培养和呼吸道免疫荧光、ELISA方法检测呼吸道常见病毒。结果: (1)410例病原体检出阳性(阳性率71 7% ),其中单纯细菌阳性162例,单纯病毒阳性152例,单纯肺炎支原体阳性18例,混合阳性78例。(2)主要细菌为副流感嗜血杆菌36株、肺炎链球菌26株、流感嗜血杆菌25株、肺炎克雷伯菌24株、大肠埃希菌22株、阴沟肠杆菌9株。大肠埃希菌、肺炎克雷伯菌除对亚胺培南、派拉西林他唑巴坦、头孢西丁、阿米卡星敏感外,对其他抗菌素的耐药性> 50%,肺炎链球菌对红霉素、复方新诺明、四环素的耐药性分别高达85 7%、78 5%、73 5%。(3)主要病毒为呼吸道合胞病毒(RSV)68例、巨细胞病毒(CMV)40例、腺病毒(Adv)29例、副流感病毒9例。结论:重庆地区儿童社区获得性肺炎细菌检出率略高于病毒,细菌以革兰阴性菌为主,对抗生素的耐药问题严峻;RSV是最常见的病毒病原。

Objective: To investigate the etiology and antimicrobial resistance of children with communityacquired pneumonia in Chongqing area. Method: Sputum specimens were collected from 572 children with communityacquired pneumonia. With sputum culture, bacteria were separated. And with rapid immunofluenrence and ELISA, we detected the common 7 respiratory viruses and atypical pathogens. Results: Totally pathogens were determined in 410 (71.7%) of 572 cases, including 162 strains of bacteria separation, 152 cases of viral infection and 18 cases of Mycoplasma pneumonia IgM positive. The major isolated bacteria included 36 strains of Haeophilus parahaemolyticus, 26 strains of Streptococcus pneumoniae, 25 strains of Haemophilus influenzae, 24 strains of Klebsiella pneumoniae, 22 strains of Escherichia coli, and 9 strains of Enterobacter cloacae. According to antibiotics susceptibility test, except susceptible to imipenem, piperacilin, cefoxitin,and amikacin, the resistant rate of Escherichia coli and Klebsiella pneumoniae to common antibiotics were more than 50%. The resistant rates of Streptococcus pneumonia to erythrocin trimethoprim/sulfamethoxazole and tetracycline were 85.7%, 78.5% and 73.5% respectively. The main viruses included 68 case of respiratory syncitial virus (RSV), 29 cases of adenovirus and 9 cases of parainfluenza. 40 cases were CMVIgM positive. Conclusion: From the sputum of children with communityacquired pneumonia in Chongqing area, we could isolate more Gramnegative bacteria and antibiotics resistance is very serious. RSV is the most common virus in communityacquired pneumonia of children.