儿童社区和院内获得性肺炎的病原菌检查及耐药性分析

Pathogen inspection and resistance analysis of Children with hospital and community-acquired pneumonia

目的探讨儿童社区获得性肺炎(CAP)与院内获得性肺炎(HAP)细菌病原构成及耐药性的差异,给临床提供参考。方法对本院2010年6月～2011年5月收治的CAP患儿120例,HAP患儿80例,均进行痰细菌学培养及致病菌耐药性分析。结果 120例CAP患儿共培养细菌134株,细菌构成前5位分别为肺炎链球菌、流感嗜血杆菌、肺炎克雷伯菌、卡他莫拉菌、金黄色葡萄球菌;80例HAP患儿共培养细菌94株,细菌构成前5位分别为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌;HAP患儿中大肠埃希菌耐药率与CAP无明显差异(P>0.05),HAP中肺炎克雷伯菌对头孢他啶、头孢吡肟、氨曲南、头孢哌酮、庆大霉素、SMZ+TMP耐药率远高于CAP(P<0.05);HAP阴沟肠杆菌对庆大霉素、SMZ+TMP、头孢哌酮舒巴坦耐药率明显高于CAP(P<0.05);HAP铜绿假单胞菌对头孢他啶、头孢吡肟、氨曲南、头孢哌酮、庆大霉素耐药率明显高于CAP(P<0.05);HAP鲍曼不动杆菌对头孢他啶、氨曲南、头孢哌酮、庆大霉素、SMZ+TMP耐药率明显高于CAP(P<0.05)。结论肺炎链球菌、流感嗜血杆菌在CAP致病最多,肺炎克雷伯菌、大肠埃希菌在HAP致病最多,并且HAP致病菌耐药率高于CAP。

Objective To study pathogenic bacteria constitute and drug resistance difference of children community-acquired pneumonia（CAP） and hospital-acquired pneumonia（HAP）,and provide reference for clinic.Methods One hundred and twenty cases of CAP and 80 cases of HAP from June 2010 to May 2011 were given sputum bacteriology training and pathogenic bacteria resistance analysis.Results One hundred and twenty cases of children of the CAP trained 134 strains of bacteria,and the top five bacteria were streptococcus pneumoniae,haemophilus influenzae,klebsiella pneumoniae,moraxella catarrhalis,staphylococcus aureus respectively;80 cases of HAP trained 94 strains of bacteria,and the top five bacteria were klebsiella pneumoniae,escherichia coli,pseudomonas aeruginosa,staphylococcus aureus,acinetobacter baumannii respectively;in HAP infants,drug resistance rate of escherichia coli had no obvious difference with CAP（P 0.05）,drug resistance rate of klebsiella pneumoniae to Cefotaxime,Cefepime,Aztreonam,Cefoperazone,Gentamycin,SMZ ＋ TMP were higher than CAP（P 0.05）;Drug resistance rate of enterobacter cloacae to Gentamycin,SMZ＋TMP,Cefoperazone/Sulbactam was significantly higher than the CAP（P 0.05）;Drug resistance rate of pseudomonas aeruginosa to Cefotaxime,Cefepime,Ammonia,Cefoperazone,Gentamycin were significantly higher than CAP（P 0.05）;Drug resistance rate of of baumanii to Cefotaxime,Ammonia,Cefoperazone,Gentamycin,SMZ ＋ TMP were significantly higher than CAP（P 0.05）.Conclusion Streptococcus pneumoniae,haemophilus are most in CAP,Klebsiella pneumoniae,escherichia coli are most in HAP,and drug resistance rate of HAP is higher than CAP.