儿童流感嗜血杆菌感染的临床及病原学研究

A clinical and pathogen study on Haemophilus influenzae infection of children

目的了解儿童急性下呼吸道感染(ALRI)及化脓性脑膜炎(化脑)流感嗜血杆菌(HI)的感染状况,HI对抗菌素的敏感情况。方法采用改良哥伦比亚巧克力琼脂培养基、API嗜血杆菌鉴定和药敏系统,对496例ALRI的痰标本、58例化脑的脑脊液标本、60例健康儿童的咽拭子进行分离培养。结果健康儿童HI的携带率1.7%(1/60),为HI生物Ⅷ型。痰标本中HI检出率12.5%(62/496),居检出细菌的首位;HI的生物型以Ⅲ、Ⅱ、Ⅳ型为主。HI在肺炎的检出率(13%)最高;1岁以下儿童、男性儿童HI检出率高,分别为14.4%、14.2%;1年中1月、4月HI检出率高,为17.1%、20.4%。脑脊液中未检出HI。HI肺炎的临床表现无特异。HI对阿莫西林、西力欣、利福平等未见耐药,而对苯唑青霉素均耐药。结论经规范和改进的方法采集、培养痰标本,提高了HI的分离率。HI是儿童ALRI的主要致病菌,临床上应重视呼吸道病原学研究。

Objective To understand the state of Haemophilus influenzae(HI)infection in children with acute lower respiratory tract infection (ALRI)and purulent meningitis,and to investigate its sensitivity to antibiotic.Methods496sputum specimens from children with ALRI,58cerebrospinal fluid specimens from children with purulent meningitis,and60throat swabs from healthy children were collected.Each sample was cultured on modified Columbia chocolated agar medium.The bacteria identification and drug sensitivity to HI were performed by API Haemophilus system.Result s The rate of HI healthy carrier was1.7%(1/60),the identified pathogen type was typeⅧof HI .The indentified rate of HI in sputum specimens was12.5%(62/496),which was the highest,the main types of HI were typeⅢ?Ⅱ?Ⅳ.The indentified rate of HI in pneumonia was the highest (13%).The rate of children<1year and boy were higher(14.4%,14.2%);January and April with higher identified rate too(17.1%,20.4%).HI was negative in cerebrospinal fluid.The clinical characteristics of pneumonia by HI was unspecific.Amoxicilline,cefuroxime,rifampicine and some others were most sensitive actively against HI,while oxacillin was resistant against.Conclusion The isolation rate of HI could be increased by standardized and improved methods of collecting and culturing sputum specimens.HI is the most common pathogen of ALRI in children.More attention should be paid for the pathogen study in clinical routine work.