新昌地区0～5岁儿童急性下呼吸道感染的病原菌及耐药性分析

Pathogens causing acute lower respiratory tract infections in children aged from 0 to 5 years in Xinchang and their drug resistance

目的调查分析新昌地区0～5岁儿童急性下呼吸道感染的病原菌分布及耐药性,为临床抗菌药物使用提供依据。方法对新昌地区2009年1月-2010年12月0～5岁住院儿童符合急性下呼吸道感染876例患儿进行痰液分离培养,做菌株鉴定和药敏试验。结果共分离出病原菌303株,其中革兰阳性菌占49.2%,革兰阴性菌占40.2%,真菌占10.6%;革兰阳性菌中以肺炎链球菌和金黄色葡萄球菌为主,对青霉素耐药率均>75.7%,肺炎链球菌对红霉素耐药率为90.5%;革兰阴性菌以大肠埃希菌、肺炎克雷伯菌及阴沟肠杆菌为主,对氨苄西林、哌拉西林耐药率>80.0%,而β-内酰胺酶抑制剂复合剂则抗菌活性较好,敏感的抗菌药物为亚胺培南、氟喹诺酮类、氨基糖苷类。结论由于儿科抗菌药物的广泛使用,使常见病原菌对抗菌药物的耐药性日趋严重,应加强对病原菌及耐药性的监测,促进抗菌药物的合理使用。

OBJECTIVE To investigate the distribution and drug resistance of the pathogenic bacteria causing lower respiratory infections in the children aged between 0 and 5 years in Xinchang area so as to provide basis for the clinical use of antibiotics. METHODS A total of 876 children with lower respiratory tract infections who were treated in the hospital from Jan 2009 to Dec 2010 were collected for the sputum culture, and the bacterial identification and the drug susceptibility testing were carried out. RESULTS A total of 303 strains of pathogens were isolated, including the gram-positive bacteria （49. 2%）, gram-negative bacteria （40.2%）, and fungi （10.6%）. Streptococcus pneurnoniae and Staphylococcus aureus were the main gram-positive bacteria, the drug resistance rates to penicillin was higher than 75.7%, the drug resistance rate of S. pneumoniae to erythromycin was 90. 5%; Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae were the main gram-negative bacteria,the drug resistance rates to ampicillin and piperacillin were higher than 80.00%, the complex beta-lactamase inhibitor had good antibacterialactivity, and they were susceptibce to imipenem, quinolones, and aminoglycosides. CONCLUSION The drug resistance of the common pathogers becomes increasingly serious due to the wide use of antibiotics in the pediatrics department, thus it is necessary to strengthen the monitoring of the pathogens and their drug resistance so as to promote the reasonable use of antibiotics.