儿童下呼吸道感染常见细菌病原分布及耐药现状

Common bacteria for lower respiratory tract infection in children and its current status of antibiotic resistance

下呼吸道感染(LRTI)尤其肺炎,是主要的儿童杀手。在发展中国家儿童LRTI病原菌以细菌为主。肺炎链球菌是最重要的社区获得性LRTI细菌病原。随着7价肺炎链球菌结合疫苗的应用,非疫苗血清型菌株所致的侵袭性肺炎链球菌疾病增多,且对抗生素的耐药性增强。社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)和医院获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)有着不同的遗传背景,其耐药性也有明显差异。革兰阴性杆菌仍是医院获得性LRTI的重要病原菌。社区获得性LRTI与医院获得性LRTI常见细菌病原有区别,亦有重叠。了解儿童LRTI常见细菌病原的分布及耐药现状,对指导临床合理诊治至关重要。

Lower respiratory tract infection（LRTI）,particularly pneumonia,is a leading killer of children.Bacteria are the main pathogen of LRTI in children of developing countries.Streptococcus pneumoniae is the most important pathogen causing LRTI.An increase in the incidence of invasive pneumococcal disease（IPD） caused by non-vaccine serotypes（NVTs）（serotype replacement） has been observed since the introduction of the seven-valent pneumococcal conjugate vaccine（PCV7）,and the increasing antibiotic resistance to NVTs is of particular concerns.Genetic and microbiological studies have revealed that community-associated（CA） meticillin-resistant Staphylococcus aureus（MRSA） is associated with a novel genetic profile and phenotype that distinguish it from hospital-acquired（HA） MRSA.There are obviously different antibiotic resistance between CA-MRSA and HA-MRSA.Gram-negative bacilli are still the chief pathogens in HA-LRTI.The common pathogens between CA-LRTI and HA-LRTI are different,but have overlaps.To understand the distribution and current status of antibiotic resistance to the common bacteria of LRTI in children is very important to guide clinical rational drug use.