359例儿童社区获得性肺炎咽部细菌携带状况的研究

Study of pharyngeal bacterial pathogens of community acquired pneumonia of 359 children

目的分析因社区获得性肺炎（CAP）住院儿童咽部细菌携带及常见细菌耐药状况，指导临床用药。方法选择住院的CAP患儿359例，取治疗前咽后壁呼吸道分泌物进行一般细菌培养，对阳性细菌行常规药敏定量及超广谱β内酰胺酶（ESBLs）试验。结果细菌培养阳性78例，占21．7％，共检出菌株82株（4例有2种细菌生长）。其中，革兰阴性杆菌60株，占73．2％；革兰阳性球菌22株，占26．8％。在革兰阴性杆菌中阳性率最高的为肺炎克雷伯杆菌25株，占30．5％；在革兰阳性球菌中阳性率最高的为肺炎链球菌15株，占18．3％。≤1岁患儿细菌检出率最高（34．6％，47／136）。肺炎克雷伯杆菌对阿莫西林有较高耐药性，产ESBLs株对阿莫西林／克拉维酸、美罗培南仍旧敏感，而对其他头孢菌素耐药性增高，肺炎链球菌对红霉素、克林霉素、四环素、复方新诺明耐药性高。结论CAP住院患儿咽部细菌携带以革兰阴性杆菌为主，肺炎克雷伯杆菌最常见，在革兰阳性球菌中阳性率最高的为肺炎链球菌。临床选药应避免选用耐药性高的药物。

Objective To investigate the pharyngeal bacterial pathogens of children＇s community acquired pneumonia （CAP） in hospital,and provide evidences to clinical empirical therapy. Methods Three hundred and fifty-nine patients with CAP were selected. Before the treatment, pharyngeal swabs was taken for culture to find bacteria,then to be done drug sensitivity quantitative test and examed the extended spectrum β lactamases （ESBLs）. Results The positive rate was 21.7% （78/359） and bacteria was 82 strains. It was mainly consisted with gram negative bacteria （73.2%, 60/82）, and klebsiella pneumonia （30.5%, 25/82 ）. Streptococcus pneumonia （ 18.3%, 15/82） was the most common in gram positive bacteria. Klebsiella pneumonia was resistant to amoxicillin. Drug resistance of ESBLs producing strains was increased. Streptococcus pneumonia was highly resistant to erythromycin, clindamycin,and tetracycline. The ratio of bacteria infection in infancy age （34.6% ,47/136） was higher than others. Conclusions Gram negative bacteria is significant pharyngeal bacterial pathogens in CAP of children. The most common one is klebsiella pneumonia, and the corresponding one in gram positive bacteria is streptococcus pneumonia. Clinical doctors should avoid using high antibiotic-resistance drugs.