儿童医院肺炎157例痰液病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in sputum of 157 children with pneumonia in ICU ward

目的分析医院ICU病房肺炎小儿痰液病原菌分布及耐药特征,为临床合理用药提供科学依据。方法对2016年10月至2017年10月绵阳市中心医院157例患肺炎的小儿痰液中分离的细菌进行鉴定,K-B法进行药敏分析,PCR检测相关耐药基因。结果157例小儿痰液,其中3例各分离出2株细菌,其余154例均各分离出1株细菌,共160株。鉴定后发现,G^+菌占总分离菌46.88%,以金黄色葡萄球菌和肺炎链球菌为主;G^-菌占53.12%,以大肠埃希菌和肺炎克雷伯菌为主。分离的病原菌对氨苄西林和阿莫西林普遍耐药,对庆大霉素、左氧氟沙星和万古霉素敏感。G^+菌对红霉素高度耐药,耐药基因mef A和erm B阳性检出率高。结论医院ICU病房肺炎小儿痰液以金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌和肺炎链球菌感染为主,对部分抗生素耐药严重。了解小儿肺炎痰液耐药情况,可为临床合理用药提供参考。

Objective To analyze the distribution and drug resistance of pathogens in sputum of children in ICU wards in our hospital and provide a scientific basis for clinical rational drug use.Methods The bacteria isolated from the sputum of 157 children with pneumonia from October 2016 to October 2017 in Mianyang Central Hospital were identified.Drug susceptibility analysis was carried out by the KB method and the related resistance genes were analyzed by PCR.Results A total of 160 bacteria were isolated,of which 157 strains were identified.Two bacteria were isolated from the three children’s sputum,respectively,and one bacterium was isolated from other 154 case of children’s sputum.Gram-positive bacteria accounted for 46.88%of the total isolates,primarily Staphylococcus aureus and Streptococcus pneumoniae.Gram-negative bacteria accounted for 53.12%,dominated by Escherichia coli and Klebsiella pneumoniae.The isolated pathogens were generally resistant to Ampicillin and Amoxicillin and sensitive to Gentamicin,Levofloxacin and Vancomycin.Gram-positive bacteria are highly resistant to Erythromycin,and the proportion of druG^-resistant genes mef A and erm B were high.Conclusion The main pathogens in sputum of children in ICU wards in our hospital were Staphylococcus aureus,Escherichia coli,Klebsiella pneumoniae and Streptococcus pneumoniae,which had a serious resistance to some antibiotics.To get clear information about the sputum drug resistance in children with pneumonia in our hospital could provide some knowledge for the rational use of drugs.