219株儿童下呼吸道感染病原菌分布及耐药性分析

Analysis on distribution of 219 strains of pathogenic bacteria and drug resistance of children with lower respiratory tract infection

目的分析儿童下呼吸道感染的病原菌分布及其耐药情况,为临床抗菌药物目标性治疗提供依据。方法选取2016年4月~2018年6月深圳市罗湖区妇幼保健院儿科所收治678例下呼吸道感染患儿作为研究对象,对所选取患儿进行痰培养及药敏试验,总结病原菌分布规律,分析其耐药性。结果678例下呼吸道感染患儿共检出病原菌219株,其中革兰阳性菌占71.7%(157/219)高于革兰阴性菌占28.3%(62/219),差异有统计学意义(χ2=12.781,P<0.05)。检出的革兰阳性菌主要包括金黄色葡萄球菌、化脓性链球菌、肺炎链球菌,药敏试验提示,金黄色葡萄球菌对青霉素G、氨苄西林有90%以上的耐药率,对环丙沙星、替考拉宁、万古霉素、莫西沙星、呋喃妥因、替加环素、利奈唑胺、左氧氟沙星有10%以下的耐药率,化脓性链球菌、肺炎链球菌对红霉素、克林霉素、四环素、磺胺异恶唑有60%以上的耐药率,对其他药物耐药率较低。检出的革兰阴性菌主要包括大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌,药敏试验提示,对主要革兰氏阴性菌氨苄西林耐药率最高,分别为65%、100%、100%,美罗培南耐药率最低均为0。结论应根据细菌培养结果及耐药率情况合理选用抗菌药物,提高疗效及遏制多重耐药菌产生。

Objective To analyze pathogenic bacteria distribution and drug resistance of children with lower respiratory tract infection to provide evidence for clinical targeted treatment of antibiotics.Methods 678 children with lower respiratory tract infection who were admitted and treated in department of pediatrics in Luohu District Maternal and Child Health Hospital from April 2016 to June 2018 were selected as research objects.All children underwent sputum culture and drug sensitivity test.The distribution of pathogenic bacteria was summarized and drug resistance was analyzed.Results In 678 children with lower respiratory tract infection,219 strains of pathogenic bacteria were detected.Among them,the proportion of gram-positive bacteria was 71.7%(157/219),higher than 28.3%of gram-negative bacteria(62/219),The difference was statistically significant(χ2=12.781,P<0.05).Gram-positive bacteria detected mainly included staphylococcus aureus,streptococcus pyogenes and streptococcus pneumoniae.Drug susceptibility test indicated that staphylococcus aureus had a resistance rate of more than 90%to penicillin G and ampicillin and a resistance rate of less than 10%to ciprofloxacin,teicoplanin,vancomycin,moxifloxacin,nitrofura ntoin,tigecycline,linezolid and levofloxacin.Streptococcus pyogenes and streptococcus pneumoniae had a resistance rate of more than 60%to erythromycin,clindamycin,tetracycline and sulfisoxazole,and a low resistance rate to other drugs.Gram-negative bacteria detected mainly included Escherichia coli,Klebsiella pneumonia and Acinetobacter baumannii.Drug susceptibility test indicated that ampicillin had the highest resistance rates to these main gramnegative bacteria,and the resistance rates were 65%,100%and 100%,respectively.The resistance rates of meropenem were the lowest and they were all 0.Conclusion Antibiotics should be rationally selected according to bacterial culture results and drug resistance rates to improve curative effects and contain the production of multi-drug resistant bacteria.