小儿社区获得性肺炎的细菌学检测和耐药性分析

The Detection of Bacteria and Resistance in Children Community-acquired Pneumonia

目的了解本地区小儿社区获得性肺炎的细菌谱及其细菌的耐药状况。方法将2005年1月以来符合小儿社区获得性肺炎诊断标准的2526例住院患儿作为研究对象,培养分离菌种,用VITEK-60细菌鉴定仪进行细菌鉴定。采用纸片扩散法进行药物敏感试验。结果①在2526例中获得阳性标本1338例(52.90%),培养出细菌1417株,其中G^+球菌875株(61.75%),G^-杆菌542株(38.20%),常见细菌为A群链球菌、肺炎链球菌、大肠埃希菌等8种细菌共计1121例(79.1%)。②A群链球菌对常用的8-内酰胺类抗生素敏感,对红霉素的耐药率为62.34%;肺炎链球菌对青霉素的耐药率为21.5%,对头孢呋辛、头孢曲松及阿莫西林/棒酸、哌拉西林/他唑巴坦的耐药率为7.6%~13.0%;金黄色葡萄球菌、表皮葡萄球菌对青霉素、红霉素的耐药率81%~90%,对其它β-内酰胺类抗生素的耐药率30%左右。大肠埃希氏菌对氨苄青霉素的耐药率为92.4%,对其它β-内酰胺类抗生素的耐药率及丁胺卡那霉素的耐药率为20%~30%.肺炎克雷伯杆菌对多数抗生素耐药率较高,环丙沙星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率较低(10%~12%)。铜绿假单孢菌对头孢哌酮/舒巴坦钠、哌拉西林/他唑巴坦、丁胺卡那霉素、头孢他啶、环丙沙星的耐药率为0~4.2%,对头孢曲松的耐药率为46.5%.结论本地区小儿CAP常见细菌为A群链球菌、肺炎链球菌、大肠埃希菌、金黄色葡萄球菌、表皮葡萄球菌、肺炎克雷伯氏菌、D群链球菌、铜绿假单胞菌。肺炎链球菌对青霉素有一定程度的耐药,对常见的G^-杆菌敏感的药物为头孢哌酮/舒巴坦和哌拉西林/他唑巴坦。

Objective To analysis the bacterial etiology and resistance in children community-acquired pneumonia in Weifang . Methods 2526 children were included in this study since January 2005.The standard operation procedure of clinical test and VITEK-60 were used to separate and indentify bacteria .And disk diffusion method was used for the antibiotics sensitive test .Results ①Pathogens were detected in 52.90% of study patients.Bacteria accounted for 1417 isolates,Gram positive coccus for 61.75% and Gram negative bacilli （ G-） for 38.2%.Eight bacteria such as Group A streptococcus ,Streptococcus pneumoniae ,E.coli,Staphylococcus aureus ,Epidermis staphy-lococcus,Klebsiella pneumoniae ,Group D streptococcus and Pseudomonas aeruginosa represented the greatest proportion with 79.1%.②Group A streptococcus was sensitive to β-lactam antibiotics ,and 62.34%resistance to erythromycin .For Streptococcus pneumoniae ,the rate of resistance to penicillin was 21.5%,and to cefuroxime,ceftriaxone,amoxicillin,piperacillin/tazobactam were 7.6%~13.0%.For Staphy-lococcus aureus and Epidermis staphylococcus ,the rates of resistance to penicillin and erythromycin were 81%~90%,and to other β-lactam antibiotics were 30%.For E.coli,the rate of resistance to ampicillin was 92.4%,and to otherβ-lactam antibiotics and amikacin were 20%~30%.Klebsiella pneumoniae was resist to most antibiotics ,except ciprofloxacin ,cefoperazone/sulbactam ,piperacillin/tazobactam .For Pseudo-monas aeruginosa,the rate of resistance to ceftriaxone was 46.5%,to cefoperazone/sulbactam,piperacillin/tazobactam,amikacin,ceftazidime, ciprofloxacin were 0 ~4.2%.Conclusion Group A streptococcus , Streptococcus pneumoniae , E.coli, Staphylococcus aureus , Epidermis staphylococcus ,Klebsiella pneumoniae ,Group D streptococcus and Pseudomonas aeruginosa arewere the common pathogens of community -ac-quired pneumonia in children in Weifang .Streptococcus pneumoniae iswas resistance to penicillin .Gram negative bacilli iswas sensitive to cef-operazone/sulbactam ,piperacillin/tazobactam .