儿童下呼吸道感染病原菌分布及耐药性

Bacteria distribution and drug-resistance of pathogens in children with lower respiratory tract infection

目的了解某儿童医院住院患儿下呼吸道感染的常见病原菌及其耐药情况,为临床合理用药提供依据。方法采用法国生物梅里埃VITEK2compact鉴定及药敏仪,对2010年2-9月住院的下呼吸道感染患儿痰培养所分离的菌株进行鉴定,并对主要菌种做药敏试验。结果 11785份痰标本共分离病原菌4 094株(34.74%),其中革兰阴性(G^-)杆菌2 826株(69.03%),主要为肺炎克雷伯菌(1012株)、大肠埃希菌(574株)、鲍曼不动杆菌(438株)、阴沟肠杆菌(221株)等;革兰阳性(G^+)球菌1 167株(28.50%),主要为金黄色葡萄球菌(402株)、肺炎链球菌(296株)、表皮葡萄球菌(193株)等;真菌101株(2.47%)。肺炎克雷伯菌与大肠埃希菌中产超广谱β内酰胺酶株检出率分别为23.91%和22.13%;G^-杆菌对亚胺培南高度敏感,耐药率为0.00%～2.97%。金黄色葡萄球菌中耐甲氧西林株占12.19%,表皮葡萄球菌中耐甲氧西林株占35.75%,溶血葡萄球菌中耐甲氧西林株占47.87%,上述细菌对万古霉素均高度敏感,耐药率为0.00%。检出耐万古霉素肺炎链球菌8株(2.70%),但其对利奈唑胺敏感,耐药率为0.00%。结论该儿童医院下呼吸道感染患儿存在多重耐药菌感染。临床应与微生物室密切配合,及时掌握细菌的耐药机制与变迁,根据药敏结果正确、合理使用抗菌药物,尽量减少新的耐药菌产生。

Objective To study the distribution and drug-resistance of pathogens isolated from children with lower respiratory tract infections in a hospital. Methods Bacterial strains isolated from sputum specimens from February to September,2010 were identified and performed antimicrobial susceptibility test by VITEK2compact system. Resuits A total of 4 094 strains （34. 74%） were isolated from 11 785 sputum samples, 2 826 （69. 03%） of which were gram-negative bacilli, including 1 012 strains of Klebsiella pneumoniae, 574 Escherichia coli, 438 Acinetobacter baumannii, 221 Enterobacter cloacae,and so on; 1 167 （28. 50%） strains of gram-positive cocci were detected, including 402 strains of Staphylococcus aureus, 296 Streptococcus pneumoniae, and 193 Staphylococcus epidermidis ; 101 （2. 47%） strains of fungi were also detected. Positive rate of extended-spectrum beta-lactamases in Klebsiella pneumoniae and Escherichia coli was 23. 91% and 22. 13%, respectively; gram-negative bacilli were highly sensitive to imipenem, the resistant rate was between 0. 00% - 2. 97%. 12. 19% of Staphylococcus aureus, 35. 75% of Staphylococcus epidermidis, and 47. 87% of Staphylococcus haemolyticus were methicillin-resistant, these strains were highly sensitive to vancomycin, the resistant rate was 0. 00%. Eight strains （2. 70%） of Strepto- coccus pneumoniae were resistant to vancomycin, while sensitive to linezolid, the resistant rate was 0. 00%. Conclusion There are multidmg-resistant strains in children with lower respiratory tract infection, in order to reduce the emergence of drug resistant strain, antimicrobial agents should be used according to antimicrohial susceptibility test results.