儿童细菌性肺炎的病原菌及其耐药状况分析

Pathogens of Bacterial Pneumonia in Children and Its Drug Resistance

目的探讨儿童细菌性肺炎的病原菌分布及耐药状况,旨在为临床诊治提供依据。方法选择2009年1月至2010年12月在本院就诊并确诊为细菌性肺炎的患儿892例为研究对象。对其采用本院自行设计的《儿童细菌性肺炎调查表》进行问卷调查。采集患儿下呼吸道分泌物标本。药敏试验采用双纸片扩散法进行产超广谱β-内酰胺酶(ESBLs)试验。分别对2009和2010年本院细菌性肺炎的细菌菌株构成比及细菌株耐药率进行统计学处理,并分析本组肺炎细菌产ESBLs菌检出情况(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与受试对象监护人签署临床研究知情同意书)。结果 892例受试者中共计135例患儿检出病原菌,检出率为15.13%,共检出病原菌10种、155株。其中,革兰阴性(G-)菌为64.52%(100/155),革兰阳性(G+)为35.48%(55/155)。检出细菌株以肺炎克雷伯菌、大肠埃希菌、肺炎链球菌、金黄色葡萄球菌、铜绿假单胞菌为主,分别占总菌株的22.58%,17.42%,14.84%,13.00%和10.97%。2009和2010年细菌菌株构成比比较,差异无统计学意义(P>0.05)。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌和金黄色葡萄球菌等对青霉素耐药率最高,均超过80.0%,对氨苄西林、阿莫西林的耐药率均超过77.0%。2010年检出细菌株耐药率高于2009年,2009和2010年细菌株耐药率比较,差异有统计学意义(P<0.05)。本组G-菌中,共检出产ESBLs菌40株,检出率为32.79%。结论细菌性肺炎普遍耐药,而且产ESBLs菌也有一定程度流行。

Objective To explore pathogens causing bacterial pneu monia in children and drug resistance in hospital,and supply evidence on diagno sis and therapy of a clinical basis.Methods From January 2 009 to December 2010,a total of 892 children with bacterial pneumonia were inv olved in this study.All subjects were investigation by Questionnaire of Bacte rial Pneumonia in Children and sample were collected.Antimicrobial susceptibi li ty of antibiotics was detected by Kirby-Bauer method.Producing extended spectr um β-lactamases（ESBLs） bacteria were identified by double-disk synergy test.The procedure of this study was co nsistent with ethical standard established by the committee of investigation in human beings of Obstetrics and Gynecology Hospital of Hainan Province.And it wa s approved by this committee.Guardians or patients were informed of grouping an d their written informed consent was obtained before clinical studies.Res ults A total of 155 pathogenic bacteria strains were isolated from 135 ch ildren,and isolation rate was 15.13%.The top five bacterial strains were Klebsiella p neumoniae,Escherichia coli,Streptococcus pneumoniae,Staphylococcus aure us and Pseudomonas aeruginosa,which accounted for 22.58%,17.42%,14.84%,13.00% and 10.97% of the total bacteria strains,respectively.Drug resistance r ates of Klebsiella pneumoniae,Escherichia coli,Streptococcus pneum oniae,Staphylococcus aureus and Pseudomonas aeruginosa were much more than 80% to penicillin,while much more than 77.0% to Ampicillin and amoxicillin.Drug resistance rate in 2010 was much more than that in 2009.A total of 40 pr oducing ESBLs bacteria strains were identified by double-disk synergy test amon g tep five bacterial with the detection rate of 32.79%.Conclusions All of the bacterial pneumonia in children have the drug resistant feature,and producing ESBLs bacteria are at prevalence to a certain extent.