小儿支气管哮喘急性发作期呼吸道感染的病原学检测及耐药性分析

Detection of pathogenic bacteria causing respiratory tract infections in children at excerbation stage of bronchial asthma and analysis of drug resistance

目的分析小儿支气管哮喘急性发作期呼吸道感染的病原体分布及耐药性,为临床合理用药提供参考。方法回顾性分析2009年8月-2011年9月在医院治疗的143例支气管哮喘急性发作期患儿临床资料,采集呼吸道分泌物行病原学检测,分析病原学分布特点及耐药性。结果共检出87株病毒,以合胞病毒为主,占33.3%,明显高于其他病毒的检出率(P<0.05),其他主要病毒依次为流感病毒B、流感病毒A、腺病毒,分别占19.4%、18.4%、12.7%;共检出细菌63株,其中肺炎克雷伯菌24株占38.1%,明显较其他细菌的检出率高(P<0.05),其他主要细菌依次为大肠埃希菌、金黄色葡萄球菌、肺炎链球菌,分别占22.2%、14.3%、12.7%;肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌对美罗培南、亚胺培南、阿米卡星耐药率<4.2%,对磺胺甲噁唑/甲氧苄啶的耐药率>66.7%;金黄色葡萄球菌、肺炎链球菌对磺胺甲噁唑/甲氧苄啶的耐药率>62.5%,对其他常用抗菌药物均产生了一定的耐药性。结论诱发儿童支气管哮喘疾病发作的因素有多种,在进行治疗之前应采用精准、快速的检测方法明确呼吸道感染类型,如合并病毒感染,可在应用抗菌药物的基础上给予抗病毒治疗,尽量避免患儿出现呼吸道感染。

OBJECTIVE To analyze the distribution and drug resistance of the pathogenic bacteria causing respiratory tract infections in the children at exacerbation stage of bronchial asthma so as to guide the reasonable clinical use of antibiotics.METHODS The clinical data of 143children at exacerbation stage of bronchial asthma who were treated in the hospital from Aug 2009to Sep 2011were retrospectively analyzed,the secretions collected from the respiratory tracts were performed for etiological test,then the distribution and the drug resistance were analyzed.RESULTS Totally 87strains of viruses were isolated,among which the syncytial virus was dominant with the detection rate of 33.3%,significantly higher than other species of pathogens（P〈0.05）,the influenza B virus,influenza A virus,and adenovirus were the other species of viruses,accounting for 19.4%,18.4%,and 12.7%,respectively;totally 63strains of pathogens were isolated,among which there were 24strains of Klebsiella pneumoniae,the detection rate was 38.1%,significantly higher than other species of pathogens,other major species of pathogens included Escherichia coli,Staphylococcus aureus,and Streptococcus pneumoniae,accounting for 22.2%,14.3%,and 12.7%,respectively.The drug susceptibility testing indicated that the drug resistance rates of the E.coli,S.aureus,and S.pneumoniae to meropenem,imipenem,and amikacin were less than 4.2%,the drug resistance rate to compound sulfamethoxazole was the highest（more than 66.7%）,the drug resistance rates of S.aureus,and S.pneumonia to compound sulfamethoxazole were the highest（more than 62.5%）,and the strains have produced certain drug resistance to other commonly used antibiotics.CONCLUSION There are many predisposing factors of the attach of bronchial asthma,it is necessary to determine the type of respiratory tract infections before the treatment with the accurate and rapid detection method.For the children with mixed viral infections,the antivirus therapy is recommended on the basis of use of antibiotics so as to prevent the respiratory tract infections.