儿科临床下呼吸道感染病原菌及其耐药性分析

Analysis of the pathogenic bacteria and their drug resistance of children lower respiratory tract infection

目的对临床痰标本分离菌进行耐药性监测,了解儿科临床下呼吸道感染病原菌的构成及耐药情况,为临床合理用药提供依据.方法采用回顾性方法对本院2002年1月～2003年12月临床痰培养及药物敏感试验结果进行统计、分析.结果1135份痰标本中分离出细菌521株,以革兰阴性菌为主,克雷伯菌和大肠埃希菌分别为其前一、二位,其中产ESBLs菌株中肺炎克雷伯菌位居第一,产ESBLs大肠埃希菌位列第二;革兰阳性菌中耐甲氧西林菌株中MRSE占第一位.所监测的19种抗生素中18种抗生素有不同程度的耐药.产ESBLs菌株较不产ESBLs菌株、耐甲氧西林表皮葡萄球菌(MRSE)比甲氧西林敏感的表皮葡萄球菌(MSSE)的耐药率明显升高.产ESBLs菌株对第三代头孢菌素的耐药率已达到83%以上.万古霉素及亚胺培南分别成为治疗MRSE及产ESBLs菌株的首选.对喹诺酮类抗生素的耐药率较低可能与儿科使用较少有关.结论下呼吸道感染病原菌中产ESBLs菌株所占比例较高,应引起高度重视.定期进行细菌耐药性监测对提高诊疗水平是十分必要的.

OBJECTIVE To provide the basis for using d rug reasonable, the drug resistance in the isolated sputum bacteria and composit ion of the pathogenic bacteria in lower respiratory tract had been studied.METHOD By reviewing the patients in our hospital from Jan 2002 to Dec 2003, the sputum culture and drug sensitivity were analysed.RESULTS Bacteria had been found in 521 case from 1135 sputum sp ecimen that most of them were gram negative. Pneumonia klesiella (ESBL S-produ ce) and Bacillus coli (ESBL S-produce) were the first and second in gram nega tive bacteria. MRSE is the first in gram positive bacteria. The different degree drug-resistance had been found in 18 of 19 kinds antibiotic. The drug-resista nce in ESBL S-produce bacteria were significantly higher than those of non ESB L S-produce, the same result had been found in MRSE than MSSE. The rate of dru g-resistance to three generation cephalosporin reached 83%. Imipenem and vanco mycin were the first choice in treating MRSE and ESBL S-produce bacteria. The reason of the lower drug-resistance to quinolones might be less usage in childr en.CONCLUSION More attention should be paid to ESBL S-produce ba cteria because it hold major rate in children lower respiratory tract infection. It is necessary to supervise the drug-resistance regularly.