儿童重症社区获得性肺炎病原体分布及细菌耐药情况分析

ANALYSIS OF PATHOGEN DISTRIBUTION AND BACTERIAL RESISTANCE IN CHILDREN WITH SEVERE COMMUNITY ACQUIRED PNEUMONIA

目的:探讨儿童重症社区获得性肺炎(CAP)患儿病原体分布及主要细菌耐药情况。方法:512例重症CAP患儿分别按照年龄和发病季节进行分组,采集所有患儿气道深部痰液标本,分析病原体分布及主要细菌耐药情况。结果:512例患儿中408例病原体检测呈阳性,阳性率为79.7%,其中以混合感染最多;共计检出病原体675株,细菌最多为372株(55.1%),且以革兰阴性菌为主。病原体中细菌、病毒、真菌、沙眼衣原体感染主要发生在婴儿期和冬季,肺炎支原体感染主要发生在学龄前期和夏季。革兰阳性菌中肺炎链球菌和金黄色葡萄球菌对万古霉素和利奈唑胺均敏感;肺炎链球菌对红霉素、四环素及克林霉素的耐药率均超过80%,金黄色葡萄球菌对青霉素、红霉素、克林霉素及氨苄西林的耐药率均超过50%。革兰阴性菌中大肠埃希菌、肺炎克雷伯菌对美罗培南、厄他培南、亚胺培南的敏感率均超过90%;流感嗜血杆菌对氨苄西林、复方新诺明、头孢克洛、头孢呋辛的耐药率均超过60%,大肠埃希菌和肺炎克雷伯菌对氨苄西林、头孢噻肟、头孢曲松、头孢泊污的耐药率均超过60%。结论:重症CAP患儿感染主要病原体为细菌,且混合感染较多,临床应谨慎使用抗生素。

Objective:To explore the pathogen distribution and major bacterial resistance in children with severe community acquired pneumonia(CAP).Methods:512 severe CAP children were grouped according age and onset seasons.Sputum specimen in deep airway of all the children were collected to analyze the pathogen distribution and major bacterial resistance.Results:408 children were positive for pathogen distribution among 512 children and the positive rate was 79.7%,among which mixed infection was the most.A total of 675 pathogens were detected,of which bacteria were 372 strains(55.1%)and among which gram-negative bacteria were the main pathogens.Bacterial,viral,fungal,chlamydia trachomatis infection mainly occurred in infancy stage and winter,while mycoplasma pneumoniae infection mainly occurred in early school age and summer.In gram-positive bacteria,streptococcus pneumoniae and staphylococcus aureus were sensitive to vancomycin and linazolamide;The drug resistance rate of streptococcus pneumoniae to erythromycin,tetracycline and clindamycin were more than 80%;The drug resistance rate of staphylococcus aureus to penicillin,erythromycin,clindamycin and ampicillin were more than 50%.In gram-negative bacteria,the sensitivity of escherichia coli and klebsiella pneumoniae to meropenem,ertapenem and imipenem were all over 90%;The drug resistance rate of haemophilus influenzae to ampicillin,compound neo-nomine,cefaclor and cefuroxime were over 60%;The drug resistance rate of escherichia coli and klebsiella pneumoniae to ampicillin,cefotaxime,ceftriaxone and cephalosporin were over 60%.Conclusions:Bacteria are the main pathogen in children with severe CAP,among which mixed infections were more common,antibiotics should be carefully used in clinic.