小儿下呼吸道感染病原菌分布与药敏分析

Distribution and drug susceptibility of pathogenic bacteria causing lower respiratory tract infections in children

目的了解小儿下呼吸道感染主要病原菌及其对抗菌药物的耐药性,为临床合理用药提供依据。方法对2009年1月-2010年12月下呼吸道感染患儿的临床资料进行回顾性分析,用VITEK-32全自动细菌鉴定仪进行鉴定,用K-B纸片法进行体外药敏试验,采用WHONET软件对耐药数据进行分析。结果共分离出病原菌63株,以革兰阴性菌为主占74.9%,前3位分别为肺炎克雷伯菌占30.0%、大肠埃希菌占22.9%、铜绿假单胞菌占9.9%;革兰阳性菌次之,占16.0%,前3位分别为金黄色葡萄球菌占5.0%、肺炎链球菌占4.2%、溶血葡萄球菌占2.4%;真菌位居第3,占9.1%;对革兰阴性菌敏感的药物有哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南,对革兰阳性菌敏感的药物有替考拉宁和万古霉素,左氧氟沙星也较敏感。结论小儿下呼吸道感染病原菌以革兰阴性菌为主,临床应加强监测,合理用药。

OBJECTIVE To investigate the main pathogens causing lower respiratory tract infections in children and their drug resistance so as to provide basis for clinical rational use of antibiotics.METHODS A clinical retrospective analysis of the clinical data from Jan 2009 to Dec 2010 was performed for the children with lower respiratory tract infections.VITEK-32 System was used to identify the pathogesn and K-B method was used for the antibiotics susceptibility testing,the data of drug resistance was analyzed by using WHONET software.RESULTS A total of 63 strains of pathogenic bacteria were isolated,gram-negative bacteria were the dominant pathogens,accounting for 74.9%,the top 3 pathogens were in order as follows： Klebsiella pneumoniae（30.0%）,Escherichia coli（22.9%）,and Pseudomonas aeruginosa（9.9%）;gram-positive bacteria were the next,accounting for 16.0%,the top three were Staphylococcus aureus（5.0%）,Streptococcus pneumoniae（4.2%）,and Staphylococcus hemolyticus（2.4%）;the fungi were the third,accounting for 9.11%.The antibiotics susceptibility testing showed that gram-negative bacteria were susceptible to piperacillin/tazobactam,cefoperazone/sulbactam,and imipenem,and gram-positive cocci were susceptible to teicoplanin and vancomycin,as well as levofloxacin.CONCLUSION Gram-negative bacteria are the major pathogens causing lower respiratory tract infections in children,so the clinical monitoring should be strengthened and the antibiotics should be used reasonably.