银川地区儿童社区获得性肺炎病原学研究

Etiology Characteristics of Community Acquired Pneumonia in Children of Yinchuan

目的分析银川地区儿童社区获得性肺炎(CAP)的病原菌分布特点及其与临床的关系,为合理使用抗菌药物提供依据。方法对309例CAP患儿采用一次性无菌收集器负压抽取深部呼吸道分泌物送细菌培养,做菌种鉴定和药敏试验。结果分离培养出病原菌87株,阳性率28.16%。检出细菌依次为肺炎链球菌(32.18%)、肺炎克雷伯菌(22.99%)、金黄色葡萄球菌(10.34%)、流感嗜血杆菌(10.34%)、大肠埃希菌(9.52%)、鲍曼不动杆菌(4.59%)、阴沟肠杆菌(4.59%)、产气肠杆菌(1.19%)、铜绿假单胞菌(1.19%)。肺炎链球菌主要见于3个月至5岁儿童,肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌、阴沟杆菌1岁内小儿多见,流感嗜血杆菌主要发生于1岁以上儿童,大肠埃希菌多见于3个月以下儿童。肺炎链球菌、肺炎克雷伯菌对常用抗生素有多重耐药性。结论本地区儿童CAP病原菌以肺炎链球菌、肺炎克雷伯菌、金黄色葡萄球菌、流感嗜血杆菌、大肠埃希菌等为主,各年龄段儿童感染的病原菌有所不同。最常见的肺炎链球菌、肺炎克雷伯菌对多种抗菌素耐药,临床应根据细菌培养和药敏试验结果合理选用抗生素。

Objective To investigate the pathogenic bacteria distribution of community-acquired pneumonia（CAP） in children of Yinchuan area and its clinical significance,so as to provide suggestion for optimal usage of antibiotics clinically.Methods Specimens of deep respiratory secretions of 309 children with CAP were collected with negative pressure by sterile disposable collector for bacterial culture,bacterial identification and drug sensitivity test.Results 87 strains of pathogenic bacteria were isolated（total positive rate 28.16%） as follows： Streptococcus pneumoniae（32.18%）,Klebsiella pneumoniae（22.99%）,Staphylococcus aureus（10.34%）,Hemophilies influenzae（10.34%）,Escherichia coli（9.52%）,Bauman Acinetobacter（4.59%）,Enterobacter cloacae（4.59%）,Enterobacter aerogenes（1.19%） and Pseudomonas aeruginosa（1.19%）.Streptococcus pneumoniae mainly occured in children between 3 months to 5 years old while Klebsiella pneumoniae,Staphylococcus aureus,Bauman Acinetobacter and Enterobacter cloacae were more common in infants within their first year of life.Hemophilies influenzae occured mainly in children over 1 year old,and Escherichia coli were mainly found in infants within three months.Streptococcus pneumoniae and Klebsiella pneumoniae had multiple drug resistance to commonly used antibiotics.Conclusion The pathogenic bacteria of CAP in children in Yinchuan area are mainly Streptococcus pneumoniae,Klebsiella pneumoniae,Staphylococcus aureus,Hemophilies influenzae and Escherichia coli.Pathogenic bacteria are different in different age groups.The most common seen Streptococcus pneumonia and Klebsiella pneumonia are strongly resistant to multiple antibiotics so clinicians should choose rational antibiotics according to the results of bacterial culture and drug sensitive test.