小儿下呼吸道感染病原菌的分布特征及耐药性分析

Distribution and Drug Resistance of Pathogens Causing Lower Respiratory Tract Infections in Children

目的:对儿童下呼吸道感染的病原菌分布及其耐药性进行监测与分析,为临床合理使用抗菌药物提供依据。方法:对8 842例下呼吸道感染患儿痰标本进行培养,鉴定出病原菌并进行药敏试验。结果:8 842例标本中检出病原菌3 472株,其中革兰阴性杆菌2 267株,占65.3%,以大肠埃希菌、肺炎克雷伯菌为主,其产ESBLs检出率分别为65.9%和48.1%,对三代头孢耐药率均很高,对头孢哌酮/舒巴坦和亚胺培南的耐药率很低;革兰阳性球菌981株,占28.3%,以金黄色葡萄球菌为最多,对万古霉素最敏感;真菌224株,占6.5%。结论:小儿下呼吸道感染病原菌以革兰阴性菌为主,不同菌种对抗菌药物的耐药性存在差异,在用药前积极寻找病原菌并监测细菌的耐药性,对临床合理使用抗菌药物有重要意义。

Objective： To study and analyse the pathogens causing lower respiratory tract infections in children and their drug resistance to commonly used antibiotics, so as to provide guidance for the clinical use of antibiotics. Methods： Sputum samples obtained from 8 842 children with lower respiratory trcat infections were cultured, and the pathogens were assessed and tested on the drug sensitivity. Results： A total of 3 472 strains of pathogens had been isolated from 8 842 sputum specimens of children, including 2 267 strains of gram-negative bacilli（65.3 %）, 981 strains of gram-posi- tive cocci （28. 3 %）, and 224 strains of fungi（6.5 %）. Escherichia coli and Klebsiella pneumoniae were the mian gram- negative strains in which the detection rates of extended-spectrum β-lactamases（ESBLs） were 65.9% and 48. 1% re- spectively, and the drug resistance rates of them to cefoperazone/sulbactam and imipenem were low, but to the third generation cephalosporin all reached very high; Staphylococcus aureus was the main gram positive cocci and most sus- ceptible to vancomycin. Conclusion： The gram-negative bacilli are the main pathogens in the pediatric respiratory tract infection and different bacterial species varied significantly in the antibiotics resistance. It is important for the rational use of antimicrobial in clinic that to find the pathogens and monitor the drug resistance for them on our own initiative before prescribing drugs for the patients.