206例儿童细菌性肺炎病原菌分布及耐药性分析

Distribution and Drug Resistance of Pathogenic Bacteria in 206 Children with Bacterial Pneumonia

目的了解本地区小儿肺炎细菌性病原菌的分布及耐药情况,为临床经验治疗提供参考。方法对我院儿科2008年9月-2009年9月期间因肺炎住院治疗的521例患儿,于住院当天采集合格痰液并进行细菌学培养。结果521例中分离到阳性标本206例,阳性率为39.5%,革兰阳性菌51株(24.7%),革兰阴性菌155株(75.3%),其中前三位细菌依次为流感嗜血杆菌42株(20.3%),肺炎克雷伯肺炎亚种33株(16.0%),大肠埃希菌25株(12.1%)。革兰阳性菌对万古霉素、奎奴普丁/达福普丁、左氧氟沙星敏感性较好,革兰阴性菌对亚胺培南、哌拉西林/他唑巴坦敏感性较好;白假丝酵母对五种抗真菌药物未发现耐药性。结论本地区小儿肺炎细菌感染率较高,以流感嗜血杆菌、肺炎克雷伯肺炎亚种、肺炎链球菌及金黄色葡萄球菌等为本地区儿童细菌性肺炎的常见病原菌;细菌耐药情况较严重。

Objective To understand the distribution and drug resistance of the pathogens in children with pneumonia,and to provide the reference for clinical experience treatment.Methods Qualified sputum samples were collected from 521 children with pneumonia in the first day when they were hospitalized in Department of Pediatrics,the First Hospital of Changsha,from September 2008 to September 2009 to conduct bacteriological culture of sputum.Results Among the 521 cases,206 ones were the positive samples,with the positive rate of 39.5%,including 24.7% Gram-positive bacteria （51/206） and 75.3% Gram-negative bacteria （155/206）,in which the top three bacteria were Haemophilus influenzae （42/155,20.3%）,Klebsiella pneumoniae subspecies pneumoniae （33/155,16.0%）,and Escherichia coli （25/155,12.1%）.Gram-positive bacteria were very sensitive to vancomycin,quinupristin /dafupuding,and levofloxacin,while Gram-negative bacteria were very sensitive to imipenem and piperacillin /tazobactam.Candida albicans was found sensitivity on the five kinds of antifungal drug resistance.Conclusions The high prevalence of bacterial pneumonia in children is commonly resulted from Haemophilus influenzae,Klebsiella pneumoniae subspecies pneumoniae,Streptococcus pneumoniae and Staphylococcus aureus in this region.It shows that drug-resistant bacteria are relatively serious by analyzing the sensitivity of test results.