儿童细菌性肺炎的病原菌及耐药分析

Pathogens causing bacterial pneumonia in children and drug resistance

目的了解医院临床儿童细菌性肺炎的病原菌分布、药敏率,为儿童细菌性肺炎的诊疗提供依据。方法应用K-B纸片扩散法测试细菌对抗菌药物的敏感性,产超广谱β-内酰胺酶(ESBLs)确证试验检测用双纸片扩散法,应用聚合酶链式反应(PCR)法检测铜绿假单胞菌的ESBLs基因亚型。结果分离的75株病原菌主要有:大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、金黄色葡萄球菌,检出革兰阴性菌62株,占82.7%,检出较高的为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌,分别占28.0%、18.7%、14.7%、13.3%;检出革兰阳性菌13株,占17.3%,均为金黄色葡萄球菌;75株细菌对包括青霉素、氨苄西林、头孢唑林在内的多种抗菌药物耐药,对头孢他啶、头孢噻肟耐药率相对较低;ESBLs确证试验共检出24株产ESBLs细菌,检出率为32.0%;铜绿假单胞菌的ESBLs基因亚型为多药耐药CTX-M-14、TEM或CTX-M-14、CTX-M-3的菌株。结论医院临床分离儿童细菌性肺炎的病原菌均有耐药现象,产ESBLs菌有一定程度的流行。

OBJECTIVE To investigate the pathogenic distribution and bacterial drug resistance of bacterial pneumonia in the children for the diagnosis and therapy of a clinical basis.METHODS Antimicrobial susceptibility of 10 antibiotics（penicillin,ampicillin,cefazolin,cefotaxime,ceftazidime,imipenem et al.） was detected by Kirby-Bauer method.ESBLs-producing bacteria were identified by double-disk synergy test.The PCR was used to detect the ESBL subtype gene of pseudomonas aeruginosa.RESULTS 75 pathogenic bacteria strains isolated,the main pathogens were 28.0% Escherichia coli,Klebsiella pneumoniae（18.7%）,Enterobacter cloacae（14.7%）,Pseudomonas aeruginosa（13.3%） and Staphylococcus aureus（17.3%）.75 strains of pathogenic bacteria had relatively higher resistant rates to penicillin,ampicillin,cefazolin,relatively lower resistant rate to cefotaxime and ceftazidime.24 ESBLs-producing bacteria were identified by double-disk synergy test with the detection rate of 32.0%.ESBL subtype genes of PAE were CTX-M-14,TEM or CTX-M-14,CTX-M-3.CONCLUSION All of the isolates causing bacterial pneumonia in children have the drug resistant feature,and ESBLs-producing bacteria are at prevalence to a certain extent.