2005—2007年山西省儿童医院儿童细菌性肺炎病原菌分布及耐药性变迁分析

Pathogen distribution and antibiotic resistance diversification of children bacterial pneumonia in Shanxi Province Children Hospital from 2005 to 2007

目的了解太原地区儿童细菌性肺炎病原菌的分布情况、抗菌药物的耐药情况以及近三年的变化趋势，为临床经验性治疗提供借鉴。方法对山西省儿童医院呼吸科2005年1月至2007年12月因肺炎住院治疗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。结果共分离出致病菌1674株，革兰阳性菌1312株，革兰阴性菌362株。革兰阳性菌居前五位的依次是：草绿色链球菌、肺炎链球菌、C群链球菌、肠球菌属、耐甲氧西林表皮葡萄球菌；革兰阴性菌居前五位的依次是：产ESBLs大肠埃希菌、铜绿假单孢菌、嗜麦芽寡养单孢菌、大肠埃希菌、鲍氏不动杆菌。草绿色链球菌、C群链球菌、铜绿假单孢菌检出率的增长有统计学意义（P〈0．001）；常见耐药表型ESBLs阳性菌株的检出率的增长有统计学意义（P〈0．001）。对革兰阳性菌中的草绿色链球菌和肺炎链球菌，哌拉西林、头孢曲松敏感性最好。万古霉素对全部革兰阳性菌均敏感。对革兰阴性菌中产ESBLs大肠埃希菌和不产ESBLs大肠埃希菌，亚胺培南西司他丁全部敏感，其次是头孢哌酮舒巴坦；对铜绿假单孢菌，头孢哌酮舒巴坦敏感性最好。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特点、耐药规律及其动态制定最佳的治疗方案。

Objective To investigate the pathogen distribution and antibiotic resistance diversification of bacterial pneumonia in the local infected children from Taiyuan region. Methods From Jan. 2005 to Dec. 2007,1835 children patients with bacterial pneumonia were chosen and their sputum samples were obtained and cultured. Totally 1674 strains of pathogenic bacterium were isolated and identified ,their antibiotic susceptibility were detected by TDR200B Automatic Instrument. Results In 1674 cases, 1312 strains were gram-positive bac- terium ; 362 strains were gram-negative bacterium. Streptococcus viridans, Streptococcus pneumoniae, Streptococ- cus C group, enterococcus group and methicillin resistant staphylococcus epidermidis were gram-positive bacteri- um~ primary pathogens by turns; for gram-negative bacterium, they were ESBLs E. coli, Ps. aeruginosa, Stenotro- phomonas maltophilia, E. coli and A. baumanii by turns. The increase of detection rates are statistically signifi- cant for Streptococcus viridans, Streptococcus C group and Ps. aeruginosa （ P 〈 0. 001 ） ; the increase of detection rate of ESBLs strain is also significant（ P 〈 0. 001 ）. In gram-positive bacterium, The better antibiotics for Strep- tococcus viridans and Streptococcus pneumoniae were piperaeillin and ceftriaxone; vancocin was sensitive to all gram-positive bacterium. In gram-negative bacterium,imipenem/cilastatin was the best sensitive to all ESBLs E. coli and ESBLs（-）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 pneumo- nia were maybe different in various regions. We must notice these situations and take more effective measures against them.