儿童细菌性肺炎208例主要致病菌分布及耐药性分析

目的了解本地区儿童细菌性肺炎病原菌分布及耐药情况，为临床经验性治疗提供借鉴。方法从208例患者合格痰标本中分离出214株菌株，试验方法与药敏判断均按照全国临床实验标准委员会（NCCLS）诊断标准。结果从208份标本分离出214株病原菌，感染率最高的病原菌依次为鲍曼不动杆菌（18．7％）、肺炎克雷伯菌（17．8％）、铜绿假单胞菌（15％）、金黄色葡萄球菌（7．5％）、表皮葡萄球菌（4．7％）、阴沟肠杆菌（3．7％）、白色念珠菌（3．7％）、大肠埃希细菌（2．8％）。体外药物敏感试验显示鲍曼不动杆菌、肺炎克雷伯菌、阴沟肠杆菌对亚胺培南、美洛培南、哌拉两林／他唑巴坦、头孢哌酮／舒巴坦、头孢吡肟、左旋氧氟沙星较为敏感，对氨苄西林、氨苄西林／舒巴坦、头孢唑林、头孢克肟、头孢噻肟、哌拉西林、美洛西林的耐药率大约50．0％；金黄色葡萄球菌、表皮葡萄球菌对万古霉素、替考拉啶、左旋氧氟沙星敏感性较高。结论不同地区的儿童细菌性肺炎流行菌株及其药物敏感性可能不同，应根据本地区的病原菌流行情况及耐药规律制定最佳的经验治疗方案。

Objective To investigate the distribution and the drug resistance of pathogenic bacteria of children＇s bacterial pneumonia in local area. Methods 214 strains were harvested from the phlegm samples of 208 patients, the diagnostic criteria for test and the resistance test were all according to the National Committee for Clinical Laboratory Standards （ NCCLS ）. Results The pathogenic bacteria with the high infectious rate were acinetobacter baumanuii（ 18. 7% ） ,klebsiella pneumoniae（ 17. 8% ） ,pscudomonas aeruginosa （ 15% ）, staphylococcus aureus （ 7. 5% ）, staphylococcus epidermidis （ 4. 7% ）, enterobacter cloacae （ 3.7% ）, candida albicans （3.7%） ,Escherichia coli （2. 8% ）. The ex vivo drug resistance test showed the acinetobacter baumannii ,klebsiella pneumonia and enterobacter cloacae were sensitive to imipenem, meropenem, piperacillin/sulbactam, cefoperazone/sulbactam, cefazolin and Levofloxacin, while for ampicillin, ampicillin/sulbactam, cefazolin, Cefixime, cefotaxime, piperacillin and mezlocillin, the drug resistance was about 50% ; staphylococcus aureus and Staphylococcus epidermidis had a high sensitive to Vancomycin、teicoplanin and Levofloxacin. Conclusions The drug resistance of pathogenic bacteria of children＇s bacterial pneumonia may be different in various local areas, the best treatment should be base on the epidemics and the rules in drug resistance of local area.