湖州地区2011至2013年小儿下呼吸道感染病原体及耐药分析

Etiology and drug tolerance of young children with lower respiratory tract infections in Huzhou from 2010 to 2013

目的了解本地区下呼吸道感染病原体的流行情况及耐药现状,为临床合理应用抗菌药物提供依据。方法收集2011年1月至2013年12月在湖州市中心医院确诊为下呼吸道感染患者或其他疾病合并下呼吸道感染患者1 506例,送检痰培养并采用WHONET 5.4软件进行痰培养结果及药敏分析。结果痰培养阳性的患儿656例,阳性率为43.6%。下呼吸道感染病原体中,革兰氏阴性菌居首位,占所有阳性标本的51.7%,其次为革兰阳性菌,占39.9%,真菌和其他混合菌各占4.7%、3.7%。所有病原菌中,肺炎克雷伯杆菌、大肠埃希菌、肺炎链球菌、金黄色葡萄球菌数量居前,分别为14.9%、10.8%、10.5%、10.1%。耐药菌株比例较高。结论该地区小儿下呼吸道感染主要病原体为革兰氏阴性菌,喹诺酮类及氨基糖苷类药物对革兰氏阴性杆菌有较好的敏感性。然而儿童有其自身特点,临床选择抗生素应谨慎综合考虑。

Objective To investigate the pathogenic bacteria distribution and drug tolerance in young children with lower respiratory tract infections （ LRTIs） , so as to provide evidence for clinical reasonable medication.Methods From January 2011 to December 2013 totally 1 506 cases of LRTIs or combined with LRTIs were collected in Huzhou Central Hospital.Sputum specimens were cultured and the results and drug susceptibility were analyzed with WHONET 5.4.Results There were 656 cases with positive sputum results, with positive rate of 43.6%.Among the pathogens in LRTIs, Gram-negative bacteria ranked first （51.7%）, followed by Gram-positive bacteria （39.9%）, fungus （4.7%） and other bacteria （ 3.7%） .Most of the pathogens were Gram-negative bacteria, including Klebsiella pneumoniae （14.9%）, Escherichia coli （10.8%）, Streptococcus pneumoniae （10.5%）, and Staphylococcus aureus （10.1%）.There was high proportion of drug-resistant strains.Conclusion Gram-negative bacteria are the major pathogenic bacteria in LRTIs in Huzhou.Quinolones and aminoglycoside antibiotics are rather sensitive to Gram-negative bacteria.But antibiotics should be given cautiously in clinics because of different characteristics of young children.