儿童社区获得性肺炎323例病原菌分布与耐药性研究

Detection of pathogenic bacteria and antibiotic resistance in 323 children with community acquired pneumonia

【目的】了解2008-2010年于本院住院的儿童社区获得性肺炎(community acquired pneumonia,CAP)病原菌分布及耐药情况。【方法】采用法国梅里埃ATB expression鉴定及药敏仪,对儿童CAP患儿进行痰细菌培养、鉴定及药物敏感试验。【结果】被检出的323株细菌结果中,G+球菌占38.4%,其中主要为肺炎链球菌(streptococcuspneumoniae,SP)(27.9%),金黄色葡萄球菌(staphylococcus aureus,SA)(10.5%);G-杆菌占61.6%,最常见的是大肠埃希菌(escherichia coli,E.coli)(24.5%),肺炎克雷伯杆菌(klebsiella pneumoniae,K.pn)(13.9%),流感嗜血杆菌(haemophilusinfluenzae,HI)(8%)。SP感染率>6月患儿与<6月患儿有非常显著差异,且在>6月患儿各年龄组居首位。E.coli和K.pn感染率随着年龄增长下降,<6月与>6月患儿之间有显著差异。产ESBLs株的K.pn和E.coli检出率高达71.1%和77.2%;HI对氨苄西林的耐药率为66.7%;而SP对红霉素的耐药率高达98.9%。【结论】本地区下呼吸道感染的细菌病原学的分布及变化,耐药情况,对合理选择抗生素,减缓耐药菌产生具有重要意义。

[Objective] To provide reference for the treatment for clinicians during the recent two years investigation of bacterial and antibiotic resistance analysis of hospitalized children with community acquired pneumonia（CAP）in some areas of Hanzhong. [Method] The sputum bacterial culture, identification and drug sensitive test were made for children with CAP by rench Merieux ATB expression identification and susceptibility meter. [Resultsl Of the 323 strains of bacterial pathogens, 11 kinds of bacterial pathogens were isolated. Gram-positive cocci accounted for 38. 4%. Of them were streptococcus pneumoniae （SP） （27.9 %） and staphylococcus aureus （SA） （10.5 %）. Gram-negative bacilli accounted for 61.6%, the predominant isolate was Escherichia coil （E. coil） （24. 5%）, followed by klebsiella pneumoniae （K. pn） （13.9 %） and haemophilus influenzae （HI） （8 % ）. SP infection rate was predominant in all age groups of children who were more than 6 months. There was a significant difference in S. pneumonia infection rate between children who were more than 6 moths and less than 6 moths. E. coil infection rate decreased with age. E. coli and K. pn infection rates were significantly different between children who were more than 6 moths and less than 6 moths. The detection rates of K. pneumoniae and E. coil with positive ESBLs were 71.7% and 77.2%, respectively. The resistant rate of HI to ampicillin was 66.7%. While the resistant rate of S. pneumoniae to erythromycin was 98.9%. [Conclusion] For a reasonable choice of antibiotic drugs and slowing resistant bacteria producing,it＇s significant to investegate the bacterial etiology of lower respiratory tract infection , changes in the distribution,and antibiotic resistance in Hanzhong.