小儿急性呼吸道感染细菌分布及耐药状况

Distribution and drug resistance of the isolated bacteria from children with acute respiratory infection

目的研究大连市儿童医院小儿急性呼吸道感染细菌分布及耐药状况。方法选择2006年1月至2007年2月医院门诊及病房新住院的急性呼吸道感染患儿930例,急性上呼吸道感染(AURI)364例,急性下呼吸道感染(ALRI)566例。AURI组患儿未用抗菌药物或只口服过1～2次抗菌药物,均采集咽拭子;ALRI患儿均静脉用抗菌药物>3d,采集痰液及支气管肺泡灌洗液。采用ATB系统(Bio-Merieux,法国)进行菌种鉴定,采用纸片扩散法(Kirby-Bauer)对分离菌株进行药敏试验。结果930份呼吸道分泌物分离菌株404株(43.4%),流感嗜血杆菌、副流感嗜血杆菌、肺炎链球菌分别占分离菌株的22.5%,12.1%,7.4%。AURI分离菌株中流感嗜血杆菌、副流感嗜血杆菌、肺炎链球菌分别占43.9%,22.0%,9.1%,大肠埃希菌、肺炎克雷伯杆菌、非发酵菌属各占4.5%,8.3%,3.0%。ALRI分离菌株中,上述菌株分别占12.1%,7.4%,6.6%及16.9%,13.2%,21.8%。流感及副流感嗜血杆菌对氨苄青霉素、复方新诺明耐药率分别为29.3%,32.9%,对羟氨苄/克拉维酸及头孢噻吩、头孢克洛、头孢呋辛等耐药率为10.0%～12.1%,对头孢噻肟耐药率为5.7%。AURI组与ALRI组流感及副流感嗜血杆菌对氨苄青霉素(P<0.01)、羟氨苄/克拉维酸(P<0.05)、头孢克洛(P<0.05)、四环素(P<0.05)、复方新诺明(P<0.01)等耐药率比较差异有显著性,ALRI组耐药率高于AURI组。结论监测期间大连市小儿急性呼吸道细菌感染主要流行菌株是流感及副流感嗜血杆菌,其对氨苄青霉素有较高的耐药性。ALRI与AURI细菌的分布不同,AL-RI革兰阴性杆菌所占比例较高,其中流感及副流感嗜血杆菌对常用抗菌药物氨苄青霉素、羟氨苄/克拉维酸、头孢克洛的耐药率相对较高。

Objective To study the distribution and drug resistance of the isolated bacteria from children with acute respiratory infection （ARI） in Dalian. Methods Between January 2006 and February 2007, 930 children with ARI were enrolled, including 364 with acute upper respiratory infection （AURI）, and 566 with acute lower respiratory infection （ALRI）. The AURI children, who did not receive antimierobial agent treatment or received oral antimicrobial agents 1-2 times, had bacterial cultures of pharyngeal swab. The ALRI children, who received intravenous antibacterial agents more than 3 days, had bacterial cultures of sputum and bronchoalveolar lavage fluid （BALF）. Isolated bacteria were identified by the ATB system （Bio-Mefieux, France）. Antimicrobial susceptibility testing was carried out by means of Kirby-bauer. Results A total of 404 isolates （ 43.4% ） were identified. Haernophilus influenzae, Haemophilus parainfluenzae and Streptococcus pneumoniae accounted for 22.5% , 12.1% and 7.4% respectively. In the isolates from AURI, Haemophilus influenzae, Haernophilus parainfluenzae and Streptococcus pneumoniae accounted for 43.9% , 22.0% and 9.1% respectively; Escherichia coli, Klebsiella pneumonia and Nonfermenters accounted for 4.5% , 8.3% and 3.0% respectively. In the isolates from ALRI, Haemophilus influenzae, Haemophilus parainfluenzae and Streptococcus pneumoniae accounted for 12.1%, 7.4% and 6.6% respectively; Escherichia coli, Klebsiella pneumoniae and Nonfermenters accounted for 16.9%, 13.2% and 21.8% respectively. The resistant rates of Haemophilus to ampicillin and TMP-SMZ were 29.3% and 32.9% respectively, and to amoxicillin-clavulanic acid, cefalotin, cefaclor, cefuroxime and cefotaxime were 12.1%, 10.0%, 1：0.0%, 11.4% and 5.7%, respectively. The resistant rate of Haemophilus to ampicillin, amoxicillin-clavulanic acid, cefaclor, tetracycine and TMP-SMZ in the ALRI group were significantly higher than that in the AURI group （P 〈0.05 or 0.01 ）. Conclusions In Dalian, Haemophilus was the main isolate of children with ARI. The distribution of bacteria was different between ALRI and AURI. In ALRI, Gram-negative bacilli were in a higher proportion, and the resistant rates of Haemophilus influenzae and Haemophilus parainfluenzae to ampicillin, amoxieillin-clavulanic acid and cefaclor were higher.