西安市儿童福利院小儿下呼吸道感染病原菌分析

Analysis of Pathogenic Bacteria Causing Lower Respiratory Tract Infection in Children of Xi'an Children Welfare Institute

目的:探讨西安市福利院下呼吸道感染患儿病原菌分布及常用抗菌素的耐药性,为临床用药提供参考。方法:对2014年1月至2014年12月入住我院儿科的580例西安市儿童福利院下呼吸道感染患儿的痰标本进行菌株培养鉴定和药敏试验,并探讨、分析。结果:580例患儿的痰标本分离检出病原菌148株,检出率24.7%,位于前五位的是大肠埃希菌65株,占43.9%,肺炎克雷伯菌34株,占23.0%,金黄色葡萄球菌27株,占18.2%,铜绿假单胞菌10株,占6.8%,肺炎链球菌6株,占4.1%。革兰阴性菌对美罗培南、阿米卡星均敏感,之后依次对哌拉西林/他唑巴坦、妥布霉素、左氧氟沙星、头孢西丁较敏感,对氨苄西林耐药率最高;革兰氏阳性菌对万古霉素、利奈唑胺均敏感,对红霉素、克林霉素耐药率较高,金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)占55.6%,金黄色葡萄球菌对青霉素、红霉素耐药率均>90%,肺炎链球菌对青霉素均敏感。结论:福利院下呼吸道感染患儿病原菌以革兰阴性菌为主,对临床中常用的头孢三、四代药物及氨苄西林、哌拉西林耐药率较高;MRSA在金黄色葡萄球菌中的所占比例较高;尚未发现VRSA、PRSP。

Objective： To investigate the distribution of pathogenic bacteria and the drug resistance to common antibiotics in children with lower respiratory infection in Xi＇an Children Welfare Institute,and to provide a reference for clinical application of antibacterial drugs. Methods： A total of 580 children with lower respiratory tract infection in the department of pediatrics of our hospital from January 2014 to December 2014 were included in this study,and their sputum specimens received the culture and identification of bacterial strains as well as drug sensitive test. Then,all the results were given the corresponding analysis and discussion. Results： 148 strains of pathogenic bacteria were detected from sputum specimens isolation of 580 children with lower respiratory tract infection,with the relevance ratio of 24. 7%. The top five strains were 65 Escherichia coli（ 43.9%）,34 Klebsiella pneumoniae（ 23%）,27 Staphylococcus aureus（ 18.2%）,10 Pseudomonas aeruginosa（ 6.8%） and 6 Streptococcus pneumoniae（ 4.1%）. Gram-negative bacteria were sensitive to meropenem and amikacin,then relatively susceptible to piperacillin / tazobactam,tobramycin,levofloxacin and cefoxitin,but the most resistant to ampicillin. Gram-positive bacteria were sensitive to vancomycin and linezolid,but had a higher resistance to erythromycin and clindamycin. The proportion of methicillin-resistant staphylococcus aureus（ MRSA） accounted for 55.6% in staphylococcus aureus. The resistant rates of staphylococcus aureus to penicillin and erythromycin were more than 90%,and streptococcus pneumoniae was susceptible to penicillin. Conclusion： Gram-negative bacteria were the primary pathogens resulting in lower respiratory tract infection in children of Xi＇an Children Welfare Institute,and had a higher resistance to the third and fourth generation cephalosporins,ampicillin and piperacillin commonly used in clinical medication.The proportion of MRSA was higher in staphylococcus aureus,but vancomycin-resistant staphylococcus aureus（ VRSA）,penicillin-resistant streptococcus pneumoniae（ PRSP） were not found in this study. These results provided an important reference for clinical medication.