儿童社区获得性呼吸道感染病原体分布与耐药性分析

Detection of pathogens causing children community-acquired respiratory infections and drug resistance analysis

目的了解儿童社区获得性呼吸道感染病原体分布及耐药性,为临床诊治患儿和科学合理使用抗菌药物提供依据。方法收集2011年1月-2014年1月医院儿科10 895例住院患儿临床送检的痰液和鼻咽部分泌物标本,采用法国生物梅里埃公司VITEK-32全自动微生物分析仪进行病原体培养及鉴定,药敏试验采用CLSI规定的纸片扩散法(K-B)。结果 10 895例住院患儿发生社区获得性呼吸道感染7 105例,感染率65.21%;从社区获得性呼吸道感染患儿送检标本中培养出病原体1484株,其中革兰阴性菌1 073株占72.30%,革兰阳性菌149株占10.04%,真菌261株占17.59%;副流感嗜血菌对磺胺甲噁唑/甲氧苄啶的耐药率为90.40%,肺炎克雷伯菌对氨苄西林的耐药率为100.00%,大肠埃希菌对头孢噻肟、氨苄西林的耐药率为75.00%、87.93%,金黄色葡萄球菌对青霉素和氨苄西林的耐药率分别为67.11%和68.00%。结论社区获得性呼吸道感染患儿病原体以副流感嗜血菌居首,提示社区卫生工作者应加强社区卫生宣教,在医师的指导下合理选用抗菌药物。

OBJECTIVE To understand the etiology and its drug resistance of pathogens causing children communi‐ty‐acquired respiratory infections in department of pediatrics ,so as to provide evidences for clinical diagnosis and treatment of children patients and rational drug selection .METHODS Positive pathogens and drug sensitivity test results collected from sputum specimen and throat swab of 10895 children inpatients with community‐acquired re‐spiratory infections in the Department of Pediatrics of the First Affiliated Hospital of Yangtze University from Jan .2011 to Jan .2014 were analyzed retrospectively by VITEK‐32 full automatic microorganism analyzer and K‐B method prescribed by CLSI .RESULTS Totally 7105 cases of children with community‐acquired respiratory infec‐tions were diagnosed ,and the infection rate was 65 .21% .A total of 1484 strains of pathogens were isolated from pediatric sputum specimen and throat swab in the past 3 years ,including 1 073 strains of gram‐negative bacteria , which accounted for 72 .30% ,and 149 strains of gram‐positive bacteria ,accounting for 10 .04% ,and 261 strains offungi,whichaccountedfor17.59% .Thedrugresistancerateof Haemophilusparainfluenzaetocotrimoxazole was 90 .40% ,and drug resistance rate of K lebsiella pneumoniae to ampicillin was 100 .00% .Meanwhile ,75 .00%of Escherichiacoli proved to be resistant to ampicillin and cefotaxime .The drug resistance rate of Staphylococcus aureustopenicillinandampicillinwere67.11% and68.00% respectively.CONCLUSIONSH.parainfluenzaeare the main pathogen leading to community‐acquired respiratory tract infections in local children ,suggesting that community health personnel should strengthen the community health education ,and the antibiotics should be rea‐sonably used under the guidance of doctors .