成人与儿童下呼吸道标本病原菌分布差异的比对与耐药性分析

Distribution difference of lower respiratory tract pathogens in between adults and children patients and drug resistance analysis

目的调查研究温州市中西医结合医院温州市儿童医院成人与儿童病区下呼吸道标本病原菌的分布差异与抗生素耐药性分析。方法对2010年7月至2011年6月的所有成人与儿童下呼吸道感染患者的临床标本(痰,咽拭)进行微生物检验并统计分析。结果成人感染以非发酵细菌为主,并且出现MDR/PDR现象;儿童细菌性感染以肠杆菌细菌为主;G+菌感染还是以金黄色葡萄为主,也有MRSA菌株出现,未超过15%,远远低于成人水平。铜绿假单胞菌检出率占成人下呼吸道感染的首位,头孢三、四代对成人铜绿假单胞菌耐药性在50%左右;阿米卡星有很好的敏感性,耐药率为5.2%;头孢哌酮/舒巴坦的耐药率已达20.59%;碳青霉烯类抗生素的耐药率在50%左右。成人鲍曼不动杆菌只有米诺环素、头孢哌酮/舒巴坦有较好的敏感性,耐药率在10%左右;并且已经出现全耐药菌株。儿童检出病原菌中对头孢哌酮/舒巴坦、碳青霉烯类抗生素未发现耐药菌株,对头孢三、四代仍有较好的敏感性,还没出现高耐菌株。头孢三、四代对成人肺炎克雷伯菌耐药性已高达75%左右;头孢哌酮/舒巴坦、碳青霉烯类抗生素的耐药率将达20%。儿童中MRSA检出率为13.32%,成人已高达72.15%,未发现对万古霉素、替考拉宁、利那唑胺耐药菌株。结论儿童与成人在下呼吸道感染病原菌分布与耐药性存在明显差异。应杜绝滥用抗生素,做到有的放矢。

Objective To investigate the distribution difference of lower respiratory tract pathogens in between adults and children patients, and analyze their antibiotic resistance. Method Microbiological detection and drug resistance analysis were performed to clinical specimens （phlegm, swabs ） from all adults and children with lower respiratory tract infection in Wenzhou Medicine and Children＇s Hospital during July 2010 to June 2011. Result Non-fermental bacteria including MDR/ PDR strains were the main pathogens in adults, while enterobacteriaceae bacteria was more common in children. Staphylococcus aureus was the main G~ bacteria, and MRSA strains were also found in children with a rate of 15% , much lower than in a- dults. Pseudomonas aeruginosa had the highest detection rate in adults and its resistance rates were around 50% to the 3rd/4th generation cephalosporins and carbapenems, 20.59% to eefoperazone/sulbactam, and 5.2% to amikacin; Acinetobacter bau- mannii from adult patients were only sensitive to cefoperazone/sulbactam with the resistance rate of around 10% , and pan-re- sistant strain had been found. No pathogens resistant to eefoperazone/sulbactam and carbapenems were found in children, and they were still sensitive to the 3rd,/4th generation of cephalosporins. The MRSA detection rate in children was 13.32% , while as high as 72.15% in adults. Conclusion The distribution and resistance of pathogens from lower respiratory tract infection are obviously different in between children and adults. Antibiotic abuse should be cut off and the drugs must be used reasonably.