儿童下呼吸道感染革兰阴性菌及其耐药性研究

Study on Gram- negative bacteria causing lower respiratory tract infection in pediatric patients and drug resistance

目的了解住院儿童患者下呼吸道感染革兰阴性菌种类情况及耐药特点,为指导临床科学选用抗菌药物提供依据。方法采用细菌分离鉴定技术和药敏试验方法,对某大型综合医院住院患儿下呼吸道感染病原菌进行分离鉴定和药敏试验。结果共调查该医院确诊为下呼吸道感染患儿1 219例,从送检的痰液中分离出革兰阴性菌903株,分离率为74.08%。痰液分离的革兰阴性菌中的优势菌主要有肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌和铜绿假单胞菌,构成比依次为39.65%、32.22%、19.16%和9.08%。下呼吸道感染革兰阴性菌对多种抗菌药物普遍耐药,尤其对头孢唑林耐药率最高。结论该医院住院患儿下呼吸道感染病原菌中,革兰阴性菌占主导,且普遍耐药,提示应根据药敏试验结果选择抗菌治疗药物。

Objective To investigate the species of Gram-negative bacteria in the pediatric patients with lower respiratory tract infection and the characteristics of antibiotic resistance,and provide scientific basis for the clinical use of antimicrobial agents. Methods Bacterial separation and identification and drug sensitivity test were used to isolate and identify the pathogens and test the antibiotic resistance of all the samples collected from the inpatients with lower respiratory tract infec-tion in a large general hospital. Results A total of 1 219 children cases diagnosed with lower respiratory tract infections were investigated. 903 strains of Gram-negative bacteria were isolated from the sputum samples and the isolation rate was 74. 08%. The dominant Gram-negative bacteria isolated from the sputum were Klebsiella pneumoniae,Escherichia coli,Acin-etobacter baumannii and Pseudomonas aeruginosa,and the constituent ratio were 39. 65%,32. 22%,19. 16% and 9. 08%respectively. The Gram-negative bacteria isolated from lower respiratory tract were generally resistant to multiple antimicro-bial agents, especially with the highest resistant rates to cefazolin. Conclusion Gram-negative bacteria are dominant pathogen in children with lower respiratory tract infections and are resistant to multiple antimicrobial agents. These results indicate that the antimicrobial agents should be selected based on the susceptibility test.