儿童重症社区获得性肺部感染的病原菌分布及耐药研究

Distribution and drug resistance of pathogens isolated from children with severe community-acquired pulmonary infections

目的探究聊城市东昌府区妇幼保健重症社区获得性肺部感染儿童主要病原菌分布情况及菌株耐药情况,为肺部感染患儿的治疗提供依据。方法选取2013年1月-2015年12月医院临床确诊为肺炎且经痰培养证实为肺部感染的422例患儿为研究对象,收集患儿痰液进行病原菌培养与检测,使用MIC或K-B纸片扩散法进行药敏试验。结果肺部感染患儿共检测痰液样本422份,共检出病原菌422株,其中革兰阴性菌245株,占58.1%,革兰阳性菌176株,占41.7%,真菌1株,占0.2%;药敏试验结果发现革兰阴性菌中肺炎克雷伯菌、大肠埃希菌和嗜血杆菌属对哌拉西林、氨苄青霉素等的耐药率达90%,对阿米卡星、左氧氟沙星、亚胺培南和美洛培南高度敏感;革兰阳性菌中金黄色葡萄球菌对氨苄青霉素、哌拉西林耐药率接近100%,对环丙沙星、庆大霉素、左氧氟沙星、万古霉素、利福平等药物高度敏感。结论儿童获得性肺部感染病原菌以革兰阴性菌为主,病原菌对哌拉西林和氨苄青霉素耐药性较强,临床治疗时应针对性应用抗菌药物,以提高患儿治疗效果。

OBJECTIVE To investigate the distribution and drug resistance of major species of pathogens isolated from children with severe community-acquired pulmonary infections in the Maternal and Child Health Care Hospital of Dongchangfu District Liaocheng so as to provide guidance for treatment of the children with pulmonary infections.METHODS From Jan 2013 to Dec 2015,a total of 422 children who were clinically diagnosed with pneumonia and were confirmed with pulmonary infections through sputum culture were recruited as the study objects,the sputum specimens were collected for culture of pathogens,and the drug susceptibility testing was performed with the use of MIC or K-B disk diffusion method.RESULTS Totally 422 strains of pathogens were isolated from 422 sputum specimens that were obtained from the children with pulmonary infections,including 245（58.1%）strains of gram-negative bacteria,176（41.7%）strains of gram-positive bacteria,and 1（0.2%）strain of fungus.The result of the drug susceptibility testing showed that among the gram-negative bacteria,the drug resistance rates of Klebsiella pneumoniae,Escherichia coli and Haemophilus to piperacillin and ampicillin were as high as 90%,the strains were highly susceptible to amikacin,levofloxacin,imipenem,and meropenem;among the gram-positive bacteria,the drug resistance rate of Staphylococcus aureus to ampicillin and piperacillin was approximately 100%,and the strains were highly susceptible to ciprofloxacin,gentamicin,levofloxacin,vancomycin,and rifampicin.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the children with community-acquired pulmonary infections.The pathogens are highly resistant to piperacillin and ampicillin.It is necessary for the hospital to reasonably use antibiotics so as to improve the therapeutic effect.