2011-2015年小儿下呼吸道感染病原学分布及药敏分析

Pathogenic distribution and drug sensitivity analysis among children with lower respiratory tract infection from 2011 to 2015

目的研究小儿下呼吸道感染病原学分布构成以及对药物敏感度的情况分析,为临床合理利用抗生素提供依据。方法选取2011-2015年诊断为小儿下呼吸道感染的2 000例患儿作为本次研究的对象,对所有的患儿留取痰液标本进行分离培养,做细菌检测和药物过敏试验分析及呼吸道病毒免疫荧光检测,同时对患儿行血清肺炎支原体抗体检测。结果 2 000例患儿中有796例患儿血清肺炎支原体抗体检测阳性(滴度>1∶40),所占比例为39.80%。有264例患儿呼吸道病毒免疫荧光试验阳性,所占比例为13.20%,其中呼吸道合胞病毒211株,占79.92%,腺病毒13株,占4.92%,流感病毒A型10株,占3.79%,流感病毒B型9株,占3.41%,副流感病毒1型6株,占2.27%,副流感病毒2型5株,占1.89%,副流感病毒3型15株,占5.68%,2种病毒同时感染3株,占1.14%,3种病毒同时感染1株,占0.38%。有543例患儿痰培养阳性,占27.15%;检测到细菌株数587例,占29.35%,其中细菌合并支原体感染78例,占3.90%;细菌合并呼吸道病毒感染35例,占1.75%,肺炎支原体合并呼吸道病毒感染47例,占2.35%,细菌、呼吸道病毒、肺炎支原体同时感染7例,占0.35%;最为主要的病原性细菌有以下5种:肺炎链球菌205株,占34.92%、金黄色葡萄球菌170株,占28.96%、流感嗜血杆菌70株,占11.93%、肺炎克雷伯菌32株,占5.45%、大肠埃希菌19株,占3.24%,共占细菌总数的84.50%;其中对革兰氏阳性病原菌比较敏感的抗生素主要有万古霉素、哌拉西林他唑巴坦、阿莫西林克拉维酸等。对革兰氏阴性病原菌比较敏感的抗生素主要有美罗培南、亚胺培南、哌拉西林他唑巴坦、阿莫西林克拉维酸、头孢曲松等。而在肺炎克雷伯杆菌中,检测到产酶菌株有13株,占40.63%;在大肠埃希菌中,检测到产酶菌株有9株,占47.37%。在产酶和非产酶的革兰氏阴性菌对美罗培南、亚胺培南的敏感性都很高。结论小儿下呼吸道病菌感染的病原比较复杂,对药敏的敏感度也各不相同,值得临床上应给予高度重视。

Objective To research the pathogenic distribution and drug sensitivity among children with lower respiratory tract infection,provide a basis for clinical rational use of antibiotics. Methods A total of 2 000 children diagnosed as lower respiratory tract infection from2011 to 2015 were selected,sputum specimens were isolated and cultured,bacterial detection,drug allergy test,and immunofluorescence detection of respiratory viruses were conducted,at the same time,serum antibody detection of Mycoplasma pneumoniae was carried out. Results Among 2 000 children,796 children were found with positive serum Mycoplasma pneumoniae antibody（ titer 1∶ 40）,accounting for39. 80%; 264 children were found with positive respiratory tract viral immunofluorescence test result,accounting for 13. 20%,including 211 strains of respiratory syncytial virus（ 79. 92%）,13 strains of adenovirus（ 4. 92%）,10 strains of influenza virus type A（ 3. 79%）,9 strains of influenza virus type B（ 3. 41%）,6 strains of parainfluenza virus type 1（ 2. 27%）,5 strains of parainfluenza virus type 2（ 1. 89%）,15 strains of parainfluenza virus type 3（ 5. 68%）; two kinds of viral infection was found in three strains（ 1. 14%）,three kinds of viral infection was found in one strain（ 0. 38%）. A total of 543 children were found with positive sputum culture result,accounting for27. 15%; 587 bacterial strains were detected,accounting for 29. 35%,including 78 cases（ 3. 90%） with bacterial infection combined with mycoplasma infection,35 cases（ 1. 75%） with bacteria infection combined with respiratory virus infection,47 cases（ 2. 35%） with mycoplasma pneumoniae infection combined with respiratory virus infection,7 cases（ 0. 35%） with bacteria infection combined with respiratory virus infection and Mycoplasma pneumoniae infection. The most important pathogenic bacteria included Streptococcus pneumoniae（ 205 strains,34. 92%）,Staphylococcus aureus（ 170 strains,28. 96 %）,Haemophilus influenzae（ 70 strains,11. 93%）,Klebsiella pneumoniae（ 32 strains,5. 45%）,Escherichia coli（ 19 strains,3. 24%）,accounting for 84. 50%. Gram- positive pathogens were sensitive to vancomycin,piperacillin- tazobactam,amoxicillin,and clavulanic acid; Gram- negative pathogens were sensitive to meropenem,imipenem,piperacillin- tazobactam,amoxicillin clavulanic acid,and ceftriaxone; 13 Klebsiella pneumoniae strains produced enzyme,accounting for40. 63%; 9 Escherichia coli strains produced enzyme,accounting for 47. 37%; Gram- negative bacteria producing and not producing enzyme were sensitive to meropenem and imipenem. Conclusion The pathogens of children with lower respiratory tract infection are complex,whose sensitivities to drugs are various,more attention should be paid to in clinic.