牡丹江地区小儿支气管肺炎常见病原菌分布及耐药情况调查

Distribution and drug resistance of common pathogenic bacteria isolated in small children with bronchopneumonia in Mudanjiang area

目的了解黑龙江省牡丹江地区小儿支气管肺炎常见病原菌分布及耐药情况,为小儿支气管肺炎的治疗及预防提供理论依据。方法采用随机抽样方法抽取2015年12月—2016年12月牡丹江医学院附属红旗医院收治的200例小儿支气管肺炎患者,采集其深部痰标本进行病原菌分离培养和药敏试验,分析小儿支气管肺炎的常见病原菌分布及耐药情况。结果牡丹江地区200例小儿支气管肺炎患者中,痰液标本细菌培养为阳性者84例,阳性率为42.00%;分离的84株细菌中,革兰氏阳性菌29株(34.52%),革兰氏阴性菌55株(65.48%);居于前2位的革兰氏阳性菌分别为金黄色葡萄球菌和肺炎链球菌,两者占革兰氏阳性菌的72.41%;居于前2位的革兰氏阴性菌分别为肺炎克雷伯菌和大肠埃希菌,两者占革兰氏阴性菌的70.91%;药敏试验结果显示,金黄色葡萄球菌和肺炎链球菌对氨苄西林/舒巴坦、四环素、青霉素G、苯唑西林和氨苄西林的耐药性均较高;肺炎克雷伯菌对氨苄西林/舒巴坦、氨苄西林、氨曲南、复方新诺明和头孢呋辛的耐药性较高,大肠埃希菌对氨苄西林/舒巴坦、氨苄西林、氨曲南、复方新诺明、头孢他啶、头孢呋辛和头孢曲松的耐药性较高。结论牡丹江地区小儿支气管肺炎病原菌以革兰氏阴性菌为主,各类细菌对常用抗菌药物均具有耐药性,临床运用抗菌药物需根据患者的感染情况合理选择耐药性低的药物进行科学治疗。

Objective To examine the distribution and drug resistance of common pathogenic bacteria isolated in small children with bronchopneumonia in Mudanjiang region of Heilongjiang province and to provide a theoretical basis for the treatment and prevention of bronchopneumonia in small children.Methods We randomly recruited 200 infants and small children receiving treatment for bronchopneumonia in Hongqi Hospital Affiliated to Mudanjiang Medical College from December 2015 through December 2016. Sputum specimens of the participants were collected for culture and drug susceptibility test of pathogenic bacteria. The distribution and antibiotic resistance of the isolated pathogenic bacteria were analyzed.Results For all the sputum specimens, totally 84 bacterial strains were isolated and the culture-positive rate was 42.00%. Of all the strains, 29 （34.52%） were gram-positive and 55 （65.48%） were gram-negative; and the detection rate of gram-negative bacteria was significantly higher than that of gram-positive bacteria. The first two identified gram-positive bacteria were Staphylococcus aureus and Streptococcus pneumoniae, accounting for 72.41% of the gram-positive strains isolated; while the first two gram-negative bacteria were Klebsiella pneumoniae and Escherichia coli, accounting for 70.91% of the gram-negative strains. Antibiotic susceptibility tests revealed highly resistant strains of Staphylococcus aureus and Streptococcus pneumoniae to ampicillin/sulbactam （Unasyn）, tetracycline, penicillin G, oxacillin, and ampicillin （AMP）; Klebsiella pneumoniae to Unasyn, AMP, aminotram （AZT）, trimethoprim-sulfamethoxazole （SMZCo）, and cefuroxime （CXM）; and Escherichia coli to Unasyn, AMP, AZT, SMZCo, cephalosporin, CXM, and ceftriaxone.Conclusion Gram-negative bacterial are major bacteria pathogens for bronchopneumonia and the isolated pathogenic bacteria of bronchopneumonia are highly resistant to antibiotics commonly used among infants and small children in Mudanjiang region; the results need to be concerned in clinical medication for the disease.