延安地区儿童急性下呼吸道感染病原菌检测分析

Etiologic analysis of children with acute lower respiratory tract infection in Yan'an region

目的了解延安地区儿童急性下呼吸道感染的病原谱,指导临床合理用药,减少耐药菌产生。方法选择2015-09~2017-09在延安大学附属医院儿科住院的急性下呼吸道感染患儿980例,收集患儿痰标本的培养结果,统计分析病原菌分布及耐药情况。结果 980例患儿痰培养阳性标本数561份,共检出653株细菌,其中革兰阴性菌371株(56.81%),以大肠埃希菌为主(21.44%);革兰阳性菌282株(43.19%),以金黄色葡萄球菌为主(15.31%)。8种主要病原菌按检出年度进行分析,结果显示3年来革兰阴性菌大肠埃希菌构成比逐年增加,革兰阳性菌金黄色葡萄球菌构成比逐年降低,而肺炎克雷伯杆菌、流感嗜血杆菌、卡他莫拉菌、鲍曼不动杆菌、肺炎链球菌及无乳链球菌3年来构成比无明显变化。革兰阴性菌对亚胺培南、美罗培南最敏感,对氨苄西林耐药率最高;革兰阳性菌对利奈唑胺及万古霉素最敏感,对青霉素耐药率最高。结论儿童下呼吸道感染病原菌以革兰阴性菌为主,临床治疗应根据药敏试验结果合理使用抗生素,降低耐药菌株的产生。

Objective To investigate the pathogen spectrum of children with acute lower respiratory tract infection in Yan＇an region for guiding the clinical rational use of antibiotics and decreasing the incidence of drug resistance.Methods A total of 980 children with acute lower respiratory tract infection were selected in the pediatric department of our hospital from September 2015 to September2017,and the results of sputum specimen culture were collected to analyze the distribution of pathogens and drug resistance.Results The positive specimens of sputum culture was found in 561 of 980 children,and a total of 653 strains of bacteria were detected.Gram-negative bacteria was found in 371 strains（56.81%）,mainly E.coli（21.44%）,and Gram-positive bacteria was found in 282 strains（43.19%）,mainly Staphylococcus aureus（15.31%）.Gram-negative bacteria E.coli gradually increased and Gram-positive bacteria Staphylococcus aureus gradually decreased in three years,but Klebsiella pneumonia,Haemophilus influenzae,Moraxella catarrhalis,Acinetobacter baumannii,Streptococcus penumoniae and Streptococcus without milk showed no significant change in three years.Gram-negative bacteria were the most sensitive to imipenem and meropenem,and the highest resistance to ampicillin.Gram-positive bacteria were the most sensitive to linezolid and vancomycin,and the highest resistance to penicillin.Conclusion Gram-negative bacteria are the main pathogens of acute lower respiratory infection in children in Yan＇an region,and the antibiotics should be used rationally according to the results of drug sensitive test in clinical therapy to reduce the production of drug resistant strains.