某医院儿童细菌性肺炎患者病原学检测及抗生素使用情况分析

Examination for the Etiology of Bacterial Pneumonia in Children and the Use of Antibiotics in a Hospital

[目的]了解儿童细菌肺炎患者病原学及药敏试验结果与抗生素使用的情况,为合理使用抗生素提供科学依据。[方法]对2007年2月至2009年11月在岢岚县人民医院内科住院治疗的408例细菌性肺炎患儿的咽部分泌物细菌分离及药敏试验结果与抗生素使用情况进行分析。[结果]采集408例患儿的咽拭子365份,细菌培养阳性的310例,阳性检出率为84.93%,检出341株细菌,其中卡他布兰汉菌112株,四联球菌71株,肺炎球菌64株,链球菌29株,其他细菌65株。常见微生物药敏试验结果,卡他布兰汉氏菌对头孢哌酮钠的耐药率只有7.14%,对氨苄西林纳、青霉素钠的耐药率分别高达75.00%、71.43%;四联球菌对环丙沙星和头孢哌酮钠的耐药率分别高达100.00%、91.55%;肺炎球菌对头孢哌酮钠的耐药率只有9.98%,对青霉素钠的耐药率高达82.81%;链球菌对氨苄西林钠、青霉素钠的耐药率高分别82.16%、72.41%,对头孢哌酮钠和阿米卡星的耐药率只有17.24%。调查408例,入院前75.25%使用过抗生素,其中单种用药的占56.68%,双联用药的占33.55%,三联用药的占6.51%,四联用药的占1.63%,用药情况不详的占1.63%;入院后病原菌不明确情况下96.08%使用2种抗生素;依据分离病原菌药敏试验结果换药者占13.24%。[结论]病原学诊断方法落后于临床需求,报告时间滞后,药敏试验与临床效果一致性差,对临床治疗指导意义较小。

[Objective]To understand the result of examination for the etiology of bacterium pneumonia and drug sensitive test in children,as well as the use of antibiotics,to provide scientific basis for rational use of antibiotics.[Methods]Isolation of bacteria of nasopharyngeal secretion collected from 408 child inpatients in Kelan County People＇s Hospital from February 2007 to November 2009 was conducted and the result of drug sensitive test,the use of antibiotics were analyzed.[Results]365 throat swab samples were collected from 408 child patients,310 of them had positive bacteria culture,accounting for 84.93%.Of the 341 bacteria detected,112,71,64,29 and 65 of them were,Micrococcus tetragenus,Pneumococcus,streptococcus and other type of bacteria.The result of drug sensitive test for general bacteria showed that the drug resistance rate of Branhamella catarrhalis against Cefoperazone sodium was 7.14%,but it was 75.00% and 71.43% against Ampicillin sodium and Penicillin G sodium salt,while the drug resistance rate of Micrococcus tetragenus against Ciprofloxacin and Cefoperazone sodium was 100.00% and 91.55% respectively,the drug resistance rate of Pneumococcus against Cefoperazone sodium and Penicillin G sodium salt was 9.98% and 82.81%.The drug resistance rate of streptococcus against Ampicillin sodium and Penicillin G sodium salt was 82.16% and 72.41%,while it was 17.24% against Cefoperazone sodium and Amikacin.Of the 408 cases investigated,75.25% of them were treated with antibiotics before hospitalization.The consumption of 1 kind of bacteria,combined,3,4 and unknown accounted for 56.68%,33.55%,6.51%,1.63% and 1.63% respectively.96.08% of the cases were treated with 2 kinds of antibiotics after hospitalization with unclear etiology,13.24% of them changed the drugs based on the result of drug sensitive test.[Conclusion]Etiology diagnosis method can not meet clinical need,reporting time was delayed,lacking of correspondence between the result of drug resistance test and clinical effect,there was little clinical guiding significance.