儿科住院患者下呼吸道病原菌分布及耐药性分析

Analysis of antimicrobial resistance and the profile of pathogens from lower respiratory tract infections in pediatric inpatients

目的分析我院2011—2015年我院儿科住院患者下呼吸道病原菌分布及其耐药性。方法采用全自动生化鉴定仪对痰标本分离株进行鉴定，用全自动微生物药敏系统和纸片扩散法对病原菌的耐药性进行检测，并用头孢硝噻吩纸片法对13．内酰胺酶进行检测。结果2011-2015年共分离得到下呼吸道病原菌518株，包括肺炎链球菌（21．62％）、金黄色葡萄球菌（16．99％）、流感嗜血杆菌（14．48％）、肺炎克雷伯菌（11．97％）、大肠埃希菌（8．11％）、卡他莫拉菌（5．41％）、鲍曼不动杆菌（3．86％）和铜绿假单胞菌（3．86％）等。药敏结果显示，肺炎链球菌对克林霉素（90．18％）、红霉素（92．86％）和复方新诺明（87．50％）的耐药率较高，金黄色葡萄球菌则对青霉素G（90．9l％）和红霉素（68．18％）有较强耐药性，未发现对万古霉素或利奈唑胺耐药的革兰阳性球菌。流感嗜血杆菌对氨苄西林耐药率为32％，与其β-内酰胺酶阳性率较一致，肺炎克雷伯菌和大肠埃希菌对头孢类药物（17．33％-45．33％）和喹诺酮类药物（34．67％～50．67％）耐药性较高，并发现1株碳青霉烯耐药的肺炎克雷伯菌。结论本院下呼吸道感染病原菌谱较广，主要包括多种革兰阳性球菌和革兰阴性杆菌，并对多种抗菌药物表现出较强耐药性，临床应注重合理应用相关抗生素，严格防控病原菌的医院感染及传播。

Objective To analyze the antimicrobial resistance and the profile of pathogens from lower respiratory tract infections in pediatric in patients. Methods Sputum bacterial isolates were identified by an automated biochemical identification system. Antimicrobial resistance was detected by an automated drug susceptibility detection system and the disc diffusion method. The 13-1actamases was tested by the nitrocefin disc detection method. Results Five hundred and eighteen bacterial pathogens were isolated from sputum samples during 2011-2015, including streptococcus pneumoniae （21.62%）, staphylococcus aureus （ 16.99% ）, haemophillus influenzae （ 14. 48% ）, klebsiella pneumoniae （ 11.97% ）, escheriehia coli（ 8. 11% ）, moraxelle catarrhalis （3.8%）, aeinetobaeter baumanii （3.86%） and pseudomonas aeruginosa （3.86%）. High resistant rates were detected for S. pneumoniae to clindamycin （90. 18% ）, erythromycin （92. 86% ） and sulfamethoxazole （85.50%）, while S. aureus was highly resistant to penicillin G （90. 91% ） and erythromyein （68. 18% ） . Resistance to vaneomyein and linezolid was not detected for gram positive cocci. The resistant rate to ampicillin was 32% for H. influenzae, which was in concordance with the production of β-lactamases. Relatively high resistance was detected for K. pneumoniae and E. coli to cephalosporins and quinolones. A earbapenem-resistant K. pneumoniae isolate was also detected. Conclusion Multiple bacterial species were isolated from lower respiratory tract infections in our hospital, including different species of gram positive cocci and gram negative bacilli, and these isolates exhibited high resistance to antibiotics tested. The clinical use of antibiotics and hospital infection and transmission of these pathogens should be controlled.