560例小儿肺炎痰培养及药敏分析

Sputum Culture of 560 Children with Pneumonia and Drug Sensitivity Analysis

目的了解小儿肺炎病原菌的分布及耐药性,指导临床合理用药。方法对560例小儿肺炎的痰标本进行培养及药敏试验。结果 560例痰标本中检出病原菌312株,阳性率55.7%,其中革兰阴性菌216株(69.2%),革兰阳性菌96株(30.8%);革兰阴性菌排前几位依次为肺炎克雷伯菌(25.0%),大肠埃希菌(20.8%),副流感嗜血菌(12.8%),铜绿假单胞菌(6.4%);革兰阳性菌排前几位依次为肺炎链球菌(15.4%),表皮葡萄球菌(8.3%),金黄色葡萄球菌(5.8%);革兰阴性菌对氨苄西林耐药率最高,为95.0%～98.7%,其中产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌和大肠埃希菌的耐药性明显高于非产ESBLs,但它们对亚胺培南、β-内酰胺类复方制剂、氨基糖苷类、喹诺酮类抗菌药物具有较高的敏感性,革兰阳性菌对青霉素、克林霉素、红霉素耐药率高,但对万古霉素、利福平、左氧氟沙星敏感。结论小儿肺炎抗感染治疗,临床上应重视痰培养检查,明确病原菌的种类及药敏试验,达到合理使用抗菌药物,提高疗效,预防病原菌耐药性增加。

OBJECTIVE To investigate the pathogenic bacteria distribution of children with pneumonia and analyze the drug resistance,so as to provide reference for rational drug application in clinics.METHODS The sputum samples of 560 cases of children with pneumonia were cultured and drug sensitivity test was performed.RESULTS Among all of the 560 cases of sputum samples,there were 312 strains of pathogenic bacteria with the positive rate 55.7%,of which there were 216 Gram-negative bacteria(G-) (69.2%) and 96 Gram-positive bacteria (G+)(30.8%) strains.The main Gram-negative bacteria were Klebsiella pneumoniae (25.0%),Escherichia coli(20.8%),Haemophilus parainfluenzae(12.8%) and Pseudomonas aeruginosa (6.4%).The main Gram-positive bacteria were Streptococcus pneumoniae (15.4%),Staphylococcus epidermidis (8.3%),and S.aureus(5.8%).The drug sensitivity test results indicated that the drug resistance rate of Gram-negative bacteria against ampicillin was the highest,reaching to 95.0-98.7%.The drug resistance of the K.pneumoniae and E.coli that produced ESBLs was obviously higher than that of non-ESBLs producing bacteria.However,they were sensitive to imipenem,and compound-β-lactam,aminoglycosides and quinolones antibiotics.The drug resistance rate of Gram-positive bacteria against penicillin,clindamycin and erythromycin was high,but they were sensitive to vancomycin,rifampicin and levofloxacin.CONCLUSION When treating the children with pneumonia,the examination of the sputum culture should be paid much attention in clinics,the pathogens should be identified and the drug sensitivity should be performed,so that the rational application of antibiotics can be ensured,the efficacy can be improved and the drug resistance of pathogens can be prevented from increasing.