社区获得性肺炎患儿呼吸道分泌物分离菌株的耐药性分析

Analysis of the Antibiotic Resistance of the Pathogenic Microorganism Species of the Community Acquired Pneumonia in Children

目的:分析昆明地区社区获得性肺炎(CAP)患儿呼吸道分泌物分离菌株的构成及其对常用抗生素的耐药状况。方法:对2007年7月1日至2008年6月30日间年龄28天～8岁的1 228名诊断为社区获得性肺炎的住院患儿,用药前采集呼吸道分泌物行细菌培养和肺炎支原体(MP)、肺炎衣原体(CP)、沙眼衣原体(CT)培养法检测,采集静脉血查合胞病毒(RSV)、腺病毒(ADV)血清IgM抗体。结果:在1 228例中,呼吸道分泌物培养出细菌369株,检出率为30.0%(369/1 228)。其中革兰阳性菌226株(61.3%,226/369),肺炎链球菌(SP)数量居首位(108/226,47.8%),其次为麻疹孪生球菌(50/226,22.1%)和金黄色葡萄球菌(SA)(27/226,12.0%);革兰阴性菌143株(143/369,38.8%),大肠埃希菌及大肠埃希菌无活性株数量居首位,两种菌共51株,占35.70%(51/143),其次为克雷伯菌属(37/143,25.9%)和卡他莫拉菌(MC)(18/143,12.6%)等;检出RSV 225例、ADV13例、CP 35例、CT8例,检出率分别为18.3%、1.1%、2.9%和0.7%。结论:昆明地区小儿CAP呼吸道分泌物分离菌株,SP居革兰阳性菌首位;大肠埃希菌及大肠埃希菌无活性株居革兰阴性菌首位,细菌与其它病原体的混合感染率为7.08%(87/1228),SP耐药率均低于33%;麻疹孪生球菌对红霉素和青霉素的耐药率均为74.0%;SA对红霉素和青霉素的耐药率分别为59.3%和88.9%;大肠埃希菌的产酶率为77.8%,对多数头孢菌素类和青霉素类药物的耐药率均高于65%。

Objective： To analyze the antibiotic resistance of etiological bacterial species of the community acquired pneumonia （CAP） in children in Kunming. Methods： In the 1,228 cases of pneumonia hospitalized from July 2007 to June 2008, aged from 28 days to 8 years old, anti-respiratory syncytial virus （anti-RSV） IgM and anti-adenovirus IgM in their serum were collected in their throat swab specimens by means of sputum culture, and cultures of mycoplasma pneumoniae （ MP）, chlamydia pneumoniae （CP） and chlamydia traehomatis （CT）. Results： The positive rate of bacterial culture was 30.0% （369 strains） among the 1,228 throat swab samples. Two hundred and twenty-six strains （61.3%） were gram-positive bacteria, 143 strains （38.8%） were gram-negative bacteria. Among the 1,228 throat swab samples, 225 （ 18.3% ） had infections of RSV, 13（ 1.1% ） adenovirus, 35 （2.9%） MP and 8 （0.7%） CT. Conclutions： In the etiological bacterial species of the community acquired pneumonia （CAP）, streptococcus pneumoniae, E. coli and E. coli inactive were the main pathogens of infection. Antibiotic resistance rate of streptococcus pneumoniae was lower than 33%. The drug resistance rate to erythromycin and penicillin were both 74.0%. Staphylococcus Aureus resistance rate to erythromycin and penicillin were 59.3% and 88.9%. Enzyme production rate of E. coli was 77.8%. Besides, the drug resistance rate of E.＇coli to cephalosporins and penicillins were both higher than 65%. Mixed infections of bacteria and other pathogen were 87 （7.08%） among the 1,228 cases.