181例患儿深部痰培养细菌分布与耐药性分析

Bacterial distribution and drug resistance of dcep-suctioned sputum from 181 children with lung infection

目的了解我院儿童肺部感染病原菌分布及耐药性，指导早期经验性抗生素应用。方法统计分析了2005年1月至2007年12月我院儿科181例住院患儿深部痰细菌培养结果。结果符合条件的痰标本共分离细菌269株。其中革兰阴性菌占69．14％（186株），主要是大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷白杆菌，其对β内酰胺类抗生素有较高的耐药性，产超广谱β-内酰胺酶（ESBLs）的大肠埃希杆菌和肺炎克雷白杆菌的耐药性尤为突出，但对含β内酰胺酶抑制剂的头孢菌素和亚胺培南仍较敏感。革兰阳性菌占30．86％（83株），粪肠球菌、表皮葡萄球菌与金黄色葡萄球菌占革兰阳性球菌的前三位。除对万古霉素仍敏感外，金黄色葡萄球菌对头孢菌素以及氨基苷类抗生素的耐药率很高。结论儿童深部痰培养分离菌株以革兰阴性菌为主，其耐药性较强，特别是产ESBLs的菌株对B内酰胺类抗生素的耐药性尤为突出。革兰阳性菌以葡萄球菌、粪肠球菌为主，其耐药率均较高。

Objective To investigate the bacterial distribution and drug resistance of deep-suetioned sputum from the children with lung infections, and to analyze the reasons of antibiotics resistance of the pathogens. Methods The sputum culture reports of 181 children hospitalized with lung infection from January 2005 to December 2007 were collected and analyzed. Results A total of 269 strains were isolated from sputurn specimens, of which gram-negative bacilli and gram-positive cocci accounted for 69.14% and 30.86% respectivdy. Escherichia coli （ 17.47 % ）, Acinetobacter baumannii （ 13.75 % ）, Pseudomonas aeruginosa （13.01% ） and Klebsiella pneumoniae （11.52%） were the most common isolates of gram-negative bacilli. Their resistant rates to β-lactam antibiotics were high, which was especially obvious among the ESBL-produeing strains of Escherichia cob and Klebsiella pneumoniae. The Enterococcus faecalis （8.18 % ）, Staphylococcus epidermidis （7.06 % ） and Staphylococcus aureus （5.95 % ） were the most common strains of gram-positive cocci. No vancomycin-resistant strain was found, but resistance rates to β-lactam antibiotics and other antibiotics were high in Staphylococcus epidermidis and Staphylococcus aureus. Conclusion The most common strains cultured from the sputum specimens of the children with lung infection were gram-negative bacilli with high resistance rates to antibiotics. ESBLs producing bacilli showed especially high resistance to β-lactum antibiotics. In gram-positive cocci, both Enterococcus faecalis and Staphylococcus presented high antibiotic resistance.