儿童下呼吸道感染病原菌分布及耐药性分析

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

目的通过对下呼吸道感染患儿痰细菌培养,了解其病原菌分布及耐药性,为儿科治疗下呼吸道感染提供依据。方法收集2011年1月-2012年10月516例下呼吸道感染住院患儿资料,取痰液采用法国生物梅里埃公司ATB细菌鉴定仪和配套的鉴定板条进行鉴定,药敏试验用K-B纸片扩散法,根据CLSI 2009版药敏标准进行判断。结果 516例患儿标本中共检出病原菌205株,其中革兰阴性菌119株占58.1%,革兰阳性菌72株占35.1%,真菌14株占6.8%;检出前4位革兰阴性菌分别是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、流感嗜血菌,分别占13.6%、12.7%、11.7%、9.8%;主要革兰阳性菌为金黄色葡萄球菌和表皮葡萄球菌,分别占22.0%和8.3%;检出真菌以白色假丝酵母菌为主占5.4%;革兰阴性菌对氨苄西林的耐药率最高,分别为96.4%、92.3%、100.0%、35.0%,亚胺培南耐药率最低为0,革兰阳性菌对青霉素的耐药率最高为100.0%,对利福平和万古霉素耐药率最低为0。结论对于儿童下呼吸道感染的治疗要根据感染菌种不同,合理选择抗菌药物。

OBJECTIVE To understand the distribution and drug resistance of pathogenic bacteria from sputum culture of the children with lower respiratory tract infections so as to guide the clinical treatment of the lower respiratory tract infections. METHODS The clinical data of 516 cases of hospitalized children with lower respiratory tract infections from Jan 2011 to Oct 2012 were collected, sputum were identified by ATB bacterium identification instrument and matching identification strip of biological merry Emmanuel in France, the drug sensitive test was performed with K-B paper diffusion method and judged by CLSI 2009 susceptibility standard. RESULTS Totally 205 strains of pathogens were cultured from 516 patients, there were 119 （ 58. 1%） strains of gram-negative bacteria, 72（35. 1%）strains of gram-positive bacteria, and 14 （6. 8%）strains of fungi; the Escherichia coli （13.6 % ） , Klebsiella pneumonia （ 12. 7 % ） , Pseudomonas aeruginosa （ 11. 7 %） and Haemophilus in fluenzae （9.8%） ranked the top four species of gram-negative bacteria; the Staphylococcus aureus （22.0%） and Staphy- lococcus epidermidis （8. 3 %） were the main species of gram-positive bacteria; Candida albicans （5. 4 %） was the predominant species of fungi. The drug resistance rates of gram-negative bacteria to ampicillin were the highest, they were 96.4%, 92.3%, 100.0%, and 35.0%, respectively, and the drug resistance rate to imipenem was the lowest （0） ; the drug resistance rate of the gram-positive bacteria to penicillin was the highest （100.0 % ）, and the drug resistance rates to rifampincin and vancomycin were the lowest （0）. CONCLUSION It is necessary to reasonably use antibiotics for the treatment of lower respiratory tract infections in the children according to the species of pathogens causing infections.