高海拔地区藏族儿童急性下呼吸道感染病原菌分布与药敏分析

Etiology and analysis of drug sensitivity in Tibetan children with acute lower respiratory infection at high altitude area

目的了解高海拔地区藏族儿童急性下呼吸道感染（ALRI）患儿感染病原菌分布及药敏分析,为临床诊断与治疗提供病原学依据。方法对青海省果洛藏族自治州地区357例ALRI住院患儿,抽取痰液,分析常见病原菌的分布情况及不同年龄儿童分布特点及药物敏感性分析。结果 357份标本中共检出阳性标本103份,阳性率为28.9%,细菌病原菌前三位为金黄色葡萄球菌、肺炎克雷伯菌、肺炎链球菌;年龄分布显示,肺炎克雷伯菌、金黄色葡萄球菌和大肠埃希菌以新生儿和≤1岁的婴儿多见,流感嗜血杆菌好发于1~5岁的儿童,肺炎链球菌在任何年龄均可发病。药敏分析显示青霉素与氨苄西林对所有致病菌有很高的耐药性,万古霉素对革兰阳性菌的敏感率为100%,亚胺培南、左氧氟沙星对所有致病菌均有较高的敏感率,哌拉西林对革兰阴性菌的敏感率较高。结论高海拔地区藏族儿童各年龄组ALRI的主要病原以金黄色葡萄球菌、肺炎链球菌、肺炎克雷伯菌、大肠埃希菌、流感嗜血杆菌为主,但在不同年龄的感染率存在明显差异。亚胺培南、哌拉西林可作为儿童ALRI临床一线用药。

Objective To explore the etiology and analysis of drug sensitivity in Tibetan children with acute lower res piratory infection（ALRI） at high altitude area, to provide etiological evidence for clinical diagnosis and treatment of ALRI. Methods The bacterial pathogens data of 357 cases of hospitalized Tibetan children with ALRI were analyzed in Goulou Tibetan Autonomous Prefecture in Qinghai Province, the characteristics and distribution of common pathogens in extract nasopharyngeal secretions of different age groups children with ALRI. Results Among the 357 samples, there were 103 positive samples（28.9%）, the top three bacterial pathogens were Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae; The age distribution of bacteria showed Klebsiella pneumoniae, Staphylococcus aureus and Escherichia coli were more common in newborns and infants who less than one year old; the Haemophilus influenzae was more likely occurs in children aged 1 to 5, Streptococcus pneumoniae could occurred in any age groups. Susceptibility analysis showed that penicillin and ampicillin had very high drug resistance for all pathogens, vancomycin had100% of sensitivity against Gram-positive bacteria; Imipenem and levofloxacin had higher sensitivity for all pathogens while piperacillin only had higher sensitivity to gram-negative bacteria. Conclusion The major pathogen for Tibetan children in all age groups with ALRI at high-altitude are Staphylococcus aureus, pneumonia Klebsiella, Streptococcus pneumoniae, Escherichin and influenza Haemophilus, but the rate of infection in different age groups has significantly differences, the younger children have higher incidence of mixed infection, the mortality rate is also higher. Imipenem and piperacillin clinically can be used as the first-line drugs for children with ALRI.