我院469例儿童细菌性重症肺炎的病原菌分布及耐药性分析

Analysis of pathogen distribution and drug resistance of 469 children with severe bacterial pneumonia in our hospital

目的分析儿童细菌性重症肺炎病原菌分布及耐药情况,为临床合理选用抗菌药物提供依据。方法回顾性分析2013年6月~2018年6月我院PICU收治的469例儿童重症肺炎的相关资料,并采集患儿痰液或肺泡灌洗液进行细菌培养,对阳性标本进行细菌鉴定及药物敏感分析。结果 469例患儿共培养出298株病原菌,革兰阳性菌(G^+)126株,占42.28%,其中前三位细菌分别为肺炎链球菌(86/298,占28.86%)、金黄色葡萄球菌(39/298,占13.09%)、粪肠球菌(1/298,占0.34%);革兰阴性菌(G^-)172株,占57.72%,其中前五位细菌分别为流感嗜血杆菌(71/298,占23.83%)、肺炎克雷伯菌(22/298,占7.38%)、大肠埃希菌(20/298,占6.71%)、鲍曼不动杆菌(15/298,占5.03%)、铜绿假单胞菌(10/298,占3.36%)。本研究显示细菌性重症肺炎患儿的病原菌主要为G^-菌,其中产ESBLs大肠埃希菌检出率为65.00%(13/20),产ESBLs肺炎克雷伯菌检出率为45.45%(10/22),耐甲氧西林金黄色葡萄球菌(MRSA)检出率为17.95%(7/39)。检出的G^+菌前两位分别为肺炎链球菌和金黄色葡萄球菌,两者对万古霉素、利奈唑胺的耐药率为0,对红霉素、克林霉素、四环素均有耐药性;金黄色葡萄球菌对于青霉素、二代和三代头孢菌素类药物的耐药率较肺炎链球菌高;肺炎链球菌对复方新诺明亦有较高的耐药性。检出前五位G^-对临床常用抗菌药物均有不同程度的耐药,并且有些细菌显现出多重耐药性。结论儿童细菌性重症肺炎的病原菌谱在发生着新的变迁,应根据本地区细菌流行病学资料及其药物敏感特点,并结合患儿临床实际,合理选择有效抗菌药物进行治疗,才能显著提升儿童重症肺炎救治的成功率,并降低细菌的耐药性。

Objective To analyze the distribution and drug resistance of pathogens in children with severe bacterial pneumonia,and to provide evidence for rational selection of antibiotics in clinic. Methods The data of 469 children with severe pneumonia admitted to PICU in our hospital from June 2013 to June 2018 were retrospectively analyzed. The sputum or alveolar lavage fluid of all the patients were collected for bacterial culture,bacterial identification and drug sensitivity analysis were performed on positive samples. Results Among the 469 sputum or alveolar lavage fluid samples,298 cases showed positive bacterial culture. The pathogenic bacteria included gram-positive bacteria (G^+) and gram-negative bacteria (G^-). G^+ had 126 cases,accounted for 42.28%,with the first three bacteria were Streptococcus pneumonia (86/298,28.86%),Staphylococcus aureus (39/298,13.09%),Enterococcus faecalis (1/298,0.34%). G^- had 172 cases,accounted for 57.72%,mainly including Haemophilus influenzae (71/298,23.83 %),Klebsiella pneumoniae (22/298,7.38%),Escherichia coli (20/298,6.71%),Acinetobacter baumannii (15/298,5.03%),Pseudomonas aeruginosa (10/298,3.36%). This study showed that the pathogens of children with severe bacterial pneumonia were mainly G^-. The detection rate of ESBLs-producing Escherichia coli was 65.00%(13/20),the detection rate of Klebsiella pneumoniae producing ESBLs was 45.45%(10/22),methicillin-resistant Staphylococcus aureus (MRSA) was 17.95%(7/39). The first two G^+ bacteria detected were Streptococcus pneumoniae and Staphylococcus aureus,the resistance rates of to Vancomycin and Linezolidf both of them were 0,it was resistant to Erythromycin,Clindamycin and Tetracycline. The resistance rate of Staphylococcus aureus to Penicillin,second-generation and third-generation cephalosporins was higher than that of Streptococcus pneumonia. Streptococcus pneumoniae also showed high resistance to Cotrimoxazole. The top five G^- were resistant to commonly used clinical antibiotics in varying degrees,and some bacteria showed multiple drug resistance. Conclusion The pathogen spectrum of severe pneumonia in children is undergoing new changes. According to the data of bacterial epidemiology and the characteristics of drug sensitivity in this area,combined with the clinical reality of children,rational selection of effective antibiotics for treatment can significantly improve the success rate of treatment of severe pneumonia in children and reduce the bacterial resistance.