下呼吸道感染病儿病原菌分布及肺炎链球菌耐药分析

LOWER RESPIRATORY TRACT INFECTION IN CHILDREN:DISTRIBUTION OF PATHOGENS AND DRUG-RESISTANCE OF STREPTOCOCCUS PNEUMONIA

目的探讨我院2015年下呼吸道感染病儿病原菌分布状况及肺炎链球菌的耐药性,以期对本地区下呼吸道感染病儿临床合理用药及社区医院的经验用药提供参考。方法收集我院2015年1—12月因下呼吸道感染收治入院的2 412例病儿的合格痰标本,采用VITEK-2全自动微生物分析仪进行菌种鉴定,采用VITEK-2、ATB Expression及Etest试条进行药敏试验。结果共分离出病原菌37种,合计827株,阳性率为34.29%,其中革兰阴性杆菌452株(54.66%),革兰阳性球菌350株(42.32%)。首位致病菌为肺炎链球菌197株(23.82%),第2至6位依次为金黄色葡萄球菌138株(16.69%)、肺炎克雷伯菌106株(12.82%)、大肠埃希菌90株(10.88%)、铜绿假单胞菌57株(6.89%)及阴沟肠杆菌46株(5.56%)。197株肺炎链球菌未发现对利奈唑胺、万古霉素、左氧氟沙星耐药者;对氯霉素、头孢噻肟、头孢曲松、青霉素、复方磺胺甲基异唑、四环素及红霉素耐药率分别为5.58%、6.09%、9.64%、36.04%、64.47%、81.22%与97.46%。结论肺炎链球菌是我院小儿下呼吸道感染的优势菌,临床应及时动态监测肺炎链球菌的药敏分析结果,合理、规范用药,以减缓耐药性的产生。

Objective To analyze the pathogenic distribution in children with lower respiratory tract infection （LRTI） and drug resistance of streptococcus pneumonia in order to provide reference for rational use of drugs for the disease. Methods Sputum specimens of 2 412 children with LRTI treated in our hospital -in January-December 2015-were collected. Strain identified was done using VITEK-2 Compact Microbiology Analysis System, and a drug-sensitivity test performed using VITEK-2, ATB Expression and Etest Methods. Results A total of 37 kinds （827 strains） of pathogenic bacteria were isolated, with a positive rate of 34.29%. Of which,452 （54.66%） strains were gram-negative bacillus and 350 （42.32%） strains were gram-positive coccus. The first pathogenic bacteria were Streptococcus pneumonia （197 strains,23.82%）, and from the second to the sixth was Staphylococcus aureus （138 strains,16.69%）, Klebsiella pneumonia （106 strains,12.82%）, Escherichia coli （90 strains,10.88%）, Pseudomonas aeruginosa （57 strains,6.89%） and Enterobacter cloacae （46 strains,5.56%）. None of the 197 strains of Streptococcus pneumonia were found resistant to linezolid, vancomycin and levofloxacin, and those resistant to chloramphenicol, cefotaxime, ceftriaxone, penicillin, sulpamethoxazole complex, tetracycline and erythromycin was 5.58%, 6.09%, 9.64%, 36.04%, 64.47%, 81.22% and 97.46%, respectively. Conclusion Streptococcus pneumonia is the dominant bacteria caused lower respiratory tract infections in children treated in our hospital. In order to delay the production of drug resistance, the result of drug sensitivity test of Streptococcus pneumonia should be dynamically monitored for rational and standardized drug use to reduce production drug resistance.