儿童细菌性肺炎676例病原菌分布及耐药性分析

Pathogen distribution and antibiotic resistance analysis of 676 children bacterial pneumonia

目的了解本地区儿童细菌性肺炎病原菌分布及耐药情况,为临床经验性治疗提供借鉴。方法对我院呼吸内科2007年1月至12月因肺炎住院治疗的患儿的合格痰标本进行细菌学培养,用TDR200B细菌鉴定及药敏诊断系统进行菌株的鉴定与药物敏感性检测。结果共分离到676株致病菌,革兰阳性菌503株,占74.4%,居前三位的依次是草绿色链球菌、肺炎链球菌、C群链球菌;革兰阴性菌173株,占25.6%,居前三位的依次是大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌。革兰阳性菌中的草绿色链球菌和肺炎链球菌对哌拉西林、头孢曲松的敏感性最好,其次是头孢噻肟、阿莫西林,而C群链球菌、耐甲氧西林表皮葡萄球菌、耐甲氧西林金黄色葡萄球菌、肠球菌属、屎肠球菌等广泛耐药,所有革兰阳性菌对万古霉素全部敏感;革兰阴性菌中的产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌、大肠埃希菌对亚胺培南/西司他丁全部敏感,其次是头孢哌酮/舒巴坦,铜绿假单胞菌对头孢哌酮/舒巴坦的敏感性最好。结论不同地区的儿童细菌性肺炎流行菌株及其药物敏感性可能不同,临床应根据本地区的病原菌流行情况及耐药规律制定最佳的经验治疗方案。

Objective To investigate the pathogen distribution and antibiotic resistance of bacterial pneumonia in the local infected children. Methods From Jan. 2007 to Dee. 2007,732 children patients with bacterial pneumonia were chosen and their sputum samples were obtained and cultured. Totally 676 strains of pathogenic bacterium were isolated and identified, their antibiotic suseptibility were detected by TDR200B Automatic Instrument. Results In 676 eases, 503 strains were gram-positive bacterium, being 74.4% ; 173 strains were gram-negative bacterium, being 25,6 %. Streptococcus viridans, Streptococcus pneumoniae and Streptococcus C group were gram- positive bacterium＇s primary pathogens by turns： for gram-negative bacterium, they were E. coil, Ps. aemginosa and A. baumanii by turns. In gram-positive bacterium, the better antibiotics for Streptococcus viridans and Streptococcus pneumoniae were piperaeillin, ceftriaxone, cefotaxim and amoxicillin by turns; however, in Streptococcus C group, methicillin resistant staphylococcus aureus, methicillin resistant Staphylococcus epidermidis, enterococci and excrement enterococcus were generally drug fast; vancomycin was sensitive to all gram-positive bacterium. In gram-negative bacterium, imipenem/ cilastatin was the best sensitive to all ESBLs E. coli, ESBL.s K. pneumoniae and E. coli, the next was cefoperazone/sulbactam; nevertheless cefoperazone/sulbactam was best for Ps, aeruginosa. Conclusion The popular strains and their drug sensitivity of children bacterial pneumonia may be different in various regions, . We must pay attention to these situations and take more effective measures against them.