某院儿童呼吸道感染病原菌分布情况及耐药性变迁

Distribution and Drug Resistance Profile of Pathogens in Children with Respiratory Tract Infection

目的为临床合理应用儿童呼吸道感染抗菌药物提供依据。方法对医院2014年至2017年儿科住院患儿痰标本中检出的常见病原菌分布和药物敏感性试验结果进行回顾性分析。结果共检出1 414株细菌,其中革兰阳性菌819株(57.93%),以金黄色葡萄球菌、肺炎链球菌为主;革兰阴性菌595株(42.08%),以大肠埃希菌、流感嗜血杆菌和肺炎克雷伯菌为主。金黄色葡萄球菌在呼吸道标本中检出率最高(25.2%),耐甲氧西林金黄色葡萄球菌(MRSA)平均检出率为19.7%,以2015年检出率最高(25.7%),未发现万古霉素及利奈唑胺耐药的金黄色葡萄球菌和肺炎链球菌。肺炎链球菌对红霉素和四环素高度耐药,2017年肺炎链球菌对青霉素耐药率为1.7%;超广谱β内酰胺酶(ESBL)平均检出率,大肠埃希菌为48.1%,肺炎克雷伯菌为31.4%,均呈逐年下降趋势;大肠埃希菌对亚胺培南的耐药率2016年上升到7%以上,肺炎克雷伯菌对亚胺培南的耐药率为7.7%~17.6%;流感嗜血杆菌β内酰胺酶检出率为53.6%。结论该院儿童呼吸道感染常见病原菌的耐药现象较普遍,尤其是MRSA、碳青霉烯类耐药大肠埃希菌、肺炎克雷伯菌的检出,对临床抗感染治疗构成严重威胁,需加强儿科临床耐药监测和及时采取有效措施控制感染。

Objective To provide evidence for the rational use of antibiotics in children with respiratory tract infections.Methods The distribution of common pathogenic bacteria isolated from sputum specimens of pediatric inpatients in our hospital from 2014 to 2017 and the results of drug sensitivity tests were retrospectively analyzed.Results A total of 1 414 strains of bacteria were detected,of which 819(57.93%) strains were gram-positive bacteria,mainly Staphylococcus aureus and Streptococcus pneumoniae,595(42.08%)strains were gram-negative bacteria,mainly Escherichia coli,Haemophilus influenza and Klebsiella pneumoniae.Staphylococcus aureus had the highest detection rate(25.2%) in respiratory specimens.The average detection rate of methicillin-resistant Staphylococcus aureus(MRSA) was 19.7%,with the highest detection rate in 2015(25.7%).No vancomycin-and linezolid-resistant Staphylococcus aureus or Streptococcus pneumoniae were found.Streptococcus pneumoniae was highly resistant to erythromycin and tetracycline,and the resistance rate of Streptococcus pneumoniae to penicillin was 1.7% in 2017.The average detection rate of extended-spectrum β-lactamase(ESBL) was 48.1% in Escherichia coli and 31.4% in Klebsiella pneumoniae,which showed a decreasing trend year by year.The resistance rate of Escherichia coli to imipenem increased to more than 7% by 2016,and that of Klebsiella pneumoniae to imipenem was in the range of 7.7%-17.6%.The detection rate of β-lactamase in Haemophilus influenza was 53.6%.Conclusion Drug resistance of common pathogens in children with respiratory tract infections is common in our hospital,especially the detection of MRSA,carbapenem-resistant Escherichia coli and Klebsiella pneumoniae,which poses a serious threat to clinical anti-infective therapy.It is necessary to strengthen clinical drug resistance monitoring in pediatrics and take effective measures to control infection in time.