儿童腺样体、扁桃体肥大病原菌分布及药物敏感性分析

Pathogenic bacteria distribution and drug susceptibility analysis of hypertrophy of adenoid and tonsil in children

目的掌握珠三角地区不同年龄段儿童腺样体、扁桃体肥大的病原菌分布及药敏情况。方法收集2 365例经临床确诊为腺样体、扁桃体肥大患儿的临床资料,按年龄分为4组,采集手术摘除的实质标本行细菌、真菌培养和药敏试验。结果 2 365例患儿中2 062例培养分离出病原菌,阳性率为87.2%,病原菌以肺炎链球菌（31.2%）、金黄色葡萄球菌（22.0%）和流感嗜血杆菌（20.0%）为主。A族链球菌是2岁~5岁组的主要检出病原菌,铜绿假单胞菌有随年龄增大而检出增多的趋势,肺炎链球菌、金黄色葡萄球菌、流感嗜血杆菌则集中分布在5岁~8岁组和8岁~11岁组。肺炎链球菌对红霉素、克林霉素的耐药率达到80%以上;金黄色葡萄球菌对青霉素类、大环内酯类抗生素有较高的耐药率,达到80%~90%;流感嗜血杆菌对喹诺酮类、阿奇霉素、加酶抑制剂复合物（如阿莫西林/棒酸）、二代及三代头孢菌素类均较敏感;铜绿假单胞菌对头孢菌素类的耐药性达到20%~30%,对碳青霉烯类的耐药率较低。结论不同年龄、地区儿童腺样体扁桃体肥大的病原菌分布存在一定差异,各地应根据实验室结果选择合理抗生素,减缓耐药菌的产生。

Objective To investigate the pathogenic bacteria distribution and drug susceptibility in children with hypertrophy of adenoid and tonsil in different ages in the Pearl River Delta region. Methods Clinical data of 2 365 children diagnosed as hypertrophy of adenoid and tonsil were divided into four groups by age. The substance specimens of surgical removal were collected and cultured for bacteria and antimicrobial susceptibility test. Results 2 062 strains of bacteria were isolated from 2 365 children,with the positive rate of 87. 2%. Streptococcus pneumoniae（ 31. 2%）,Staphylococcus aureus（ 22. 0%） and Haemophilus influenzae（ 20. 0%） were the most frequently isolated pathogens. Streptococcus pyogenes A was the main pathogen bacteria in2-5 year group. The detection rate of pseudomonas aeruginosa increases with the age. Streptococcus pneumoniae,Staphylococcus aureus and Haemophilus influenzae were the main pathogen bacteria in 5-8 year group and 8-11 year group. The resistance rate of Streptococcus pneumoniae to erythromycin,clindamycin was more than 80%,the resistance rate of Staphylococcus aureus to penicillins,macrolide antibiotics was within 80%-90%. Quinolones,azithromycin,enzyme inhibitor complex（ amoxicillin / clavulanic acid）,second and third generation cephalosporins were sensitive to Haemophilus influenzae. The resistance rate of pseudomonas aeruginosa to cephalosporins was within 20%-30%,which has low resistance rate to carbapenems.Conclu sion The pathogens distribution in children with hypertrophy of adenoid and tonsil varies in different ages and different regions. As a result,in order to reduce the drug resistant strains,reasonable antibiotic use should be conducted on the laboratory results.