儿童和成人下呼吸道感染病原菌分布及耐药性差异分析

Analysis on differences in distribution and drug resistance of lower respiratory tract infection pathogenic bacteria between children and adults

目的研究儿童和成人下呼吸道感染病原菌分布及耐药性,比较两者差异,为临床合理用药提供依据,减缓耐药病原菌的产生。方法采集2014年1月至2015年10月儿童和成人下呼吸道感染患者的痰标本和支气管肺泡灌洗液,进行细菌鉴定及药敏试验,比较两者差异。结果儿童和成人患者分离的病原菌均以革兰阴性杆菌为主,分别占62.4%和89.7%,革兰阳性球菌分别占37.6%和10.3%。儿童患者分离的革兰阴性杆菌排名依次为流感嗜血杆菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、卡他莫拉菌、阴沟肠杆菌、铜绿假单胞菌;分离的革兰阳性球菌排名依次为金黄色葡萄球菌、肺炎链球菌。成人分离的革兰阴性杆菌排名依次为肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、嗜麦芽窄食单胞菌、黏质沙雷菌、大肠埃希菌、阴沟肠杆菌;分离的革兰阳性球菌排名依次为金黄色葡萄球菌、无乳链球菌、肺炎链球菌。儿童和成人患者耐甲氧西林金黄色葡萄球菌分别为12.8%和53.9%。儿童分离的革兰阴性杆菌对碳青霉烯类药耐药率较低,小于5.0%;成人对碳青霉烯类药耐药率较高,尤其是鲍曼不动杆菌,其对碳青霉烯类药耐药率大于50.0%。结论儿童和成人病原菌株分布和耐药性差异较显著,临床用药应充分考虑,为患者早期治疗提供依据,同时尽快进行药敏试验,科学合理用药。

Objective To investigate the distribution and drug resistance of pathogenic bacteria causing lower respiratory tract infection in children and adult patients and to compare their differences in order to provide a basis for reasonable drug usein clinic and slowing down the generation of drug resistant pathogenic bacteria.Methods The sputum samples and bronchial alveolar lavage fluid were collected in children and adult patients with lower respiratory tract infection from January 2014 to October 2015,then the bacterial identification and drug sensitivity test were performed for comparing the differences between them.Results The isolated pathogenic bacteria in children and adult patients were dominated by Gram-negative bacilli,accounting for 62.4% and 89.7% respectively,and Gram-positive cocci accounting for 37.6% and 10.3% respectively.Gram negative bacilli isolated from children ranked as in turn Haemophilus influenzae（Hin）,Escherichia coli（Eco）,Klebsiella pneumoniae（Kpn）,Acinetobacter baumannii（Aba）,Moraxella catarrhalis（Mc）,enterobacter cloacae（Ecl）,Pseudomonas aeruginosa（Pae）;the isolated Gram positive cocci were ranked as in turn staphylococcus aureus（Sau）andstreptococcus pneumoniae（Spn）.Gram negative bacilli isolated from adults were ranked asin trun Kpn,Aba,Pae,Pma,Sma,Eco,Ecl;Gram positive cocci were ranked as in turn Sau,streptococcus agalactiae（Sgc）and Spn.The detection rates of methicillin resistant Staphylococcus aureus（MRSA）in children and adults were 12.8% and 53.9%respectively.Gram negative bacilli isolated form children had the low resistance to carbapenem,which was less than 5.0%;For adults,the resistance of Gram negative bacilli to carbapenem was higher,especially Aba,which was more than 50.0%.Conclusion The differences in drug resistance of pathogenic bacterial strains between children and adults are more obvious,therefore which should be fully considered in clinical medication to provide the basis for the early treatment of patients,meanwhile the drug sensitivity test should be carried out as soon as possible for conduct the scientific and rational medication.