儿童呼吸道感染的病原菌分布与耐药性特点及血清相关免疫指标变化研究

Distribution and drug resistance of pathogens causing respiratory tract infections in children and serum immunological indexes

目的分析儿童呼吸道感染的病原菌分布及耐药性特点,同时进一步分析感染时机体相关免疫指标水平的变化情况,为临床治疗提供参考依据。方法选取2014年3月-2017年3月医院收治的儿童呼吸道感染患儿290例作为A组,选同期医院体检中心的健康儿童290例作为B组,采集患儿的痰液或呼吸道分泌物进行菌株鉴定,采用K-B法检测抗菌药物耐药性,免疫球蛋白应用免疫散射比浊法进行检测。结果革兰阳性菌中,金黄色葡萄球菌、肺炎链球菌对氨苄西林/舒巴坦、青霉素G、哌拉西林、左氧氟沙星、头孢呋辛钠耐药率均>50%;革兰阴性菌中大肠埃希菌对氨苄西林、头孢呋辛、呋喃妥因、氨曲南、环丙沙星、庆大霉素、头孢唑林、头孢他啶等的耐药率较高;A组患儿LgG2(1.82±0.53)、LgG4(0.23±0.19)、LgM(1.01±0.47)指标水平低于B组患儿LgG2(2.74±0.88)、LgG4(0.61±0.39)、LgM(1.85±0.56)指标水平,LgE(1.89±0.32)指标水平高于B组LgE(1.17±0.35)(P<0.05)。结论儿童呼吸道感染的常见病原菌以肺炎克雷伯菌、大肠埃希菌等革兰阴性菌为主,而上述菌种对头孢哌酮/舒巴坦、美罗培南、亚胺培南的耐药率均较低,同时儿童呼吸道感染与免疫功能紊乱具有相关性,LgG2、LgG4、LgM、LgE均可作为儿童呼吸道感染免疫功能检查的重要指标。

OBJECTIVE To investigate the distribution and drug resistance of pathgoens causing respiratory tract infections in children and observe the changes of levels of immunological indexes of the children with infections so as to provide guidance for clinical treatment.METHODS Totally 290 children with respiratory tract infections who were treated in hospitals from Mar 2014 to Mar 2017 were chosen as the group A,meanwhile,290 healthy children who received physical examination were set as the group B.The sputum specimens and respiratory tract secretions were collected from the children with respiratory tract infections,the isolated pathogens were identified,the drug resistance was determined by using K-B method,and the immunoglobulins were detected with the use of immuno-scatter turbidimetry.RESULTS Among the gram-positive bacteria,the drug resistance rates of Staphylococcus aureus and Streptococcus pneumoniae strains to ampicillin-sulbactam,penicillin G,piperacillin,levofloxacin and cefuroxime sodium were more than 50%.Among the gram-negative bacteria,the Escherichia coli strains were highly resistant to ampicillin,cefuroxime,nitrofurantoin,aztreonam,ciprofloxacin,gentamicin,cefazolin and ceftazidime.The levels of LgG2,LgG4 and LgM of the group A were respectively（1.82±0.53）,（0.23±0.19）and（1.01±0.47）,lower than（2.74±0.88）,（0.61±0.39）and（1.85±0.56）of the group B;the LgE level of the group A was（1.89±0.32）,higher than（1.17±0.35）of the group B（P0.05）.CONCLUSION The gram-negative bacteria such as Klebsiella pneumoniae and E.coli are dominant among the pathogens causing the respiratory tract infections in the children,the drug resistance rates of the above species to cefoperazone-sulbactam,meropenem and imipenem are low.The respiratory tract infections in the children are associated with the immune dysfunction.LgG2,LgG4,LgM and LgE can be served as the major indexes for immune function examination of the children with respiratory tract infections.