OSAHS患儿腺样体、扁桃体病原菌分布及耐药性变迁

Distribution and drug resistance of pathogenic bacteria of adenoids and tonsils in children with OSAHS

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿手术切除的肥大腺样体、扁桃体标本的病原菌分布及菌株耐药性变迁。方法取2013年1月至2017年12月诊断为OSAHS患儿手术切除的腺样体和(或)扁桃体组织行细菌、真菌培养鉴定及药敏试验。结果5年3425例患儿中2631例分离出病原菌共2916株,阳性率为76.82%,其中革兰阳性球菌1639株(56.21%),以金黄色葡萄球菌743株(25.48%)、肺炎链球菌578株(19.82%)和A族链球菌241株(8.30%)为主;革兰阴性杆菌1131株(38.79%),以流感嗜血杆菌613株(21.02%)和铜绿假单胞菌141株(8.26%)为主。5年来,病原菌种类和占比无显著变化。革兰阳性球菌5年未发现耐万古霉素菌株;金黄色葡萄球菌对青霉素类抗菌药物耐药率达90%以上,且对甲氧西林的耐药率呈上升趋势(χ^2=12.36,P<0.05);肺炎链球菌对克林霉素、红霉素的耐药率达到80%以上;A族链球菌对青霉素类、头孢菌素类药物100%敏感,对克林霉素、红霉素、四环素和复方磺胺甲噁唑耐药率均达70%以上。流感嗜血杆菌对氨苄西林的耐药率呈上升趋势(χ^2=10.42,P<0.05),且产β-内酰胺酶菌株检出率呈上升趋势(χ^2=10.13,P<0.05)。铜绿假单胞菌对碳青霉烯类耐药率较低,但对头孢他啶、头孢哌酮、哌拉西林/他唑巴坦的耐药率呈上升趋势(χ^2=16.24、13.22、12.01,P<0.05)。结论OSAHS患儿腺样体、扁桃体感染以革兰阳性球菌为主,目前,金黄色葡萄球菌的耐药形势严峻,流感嗜血杆菌和铜绿假单胞菌对β-内酰胺酶类药物耐药率上升,但大部分病原菌对碳青霉烯类药物尚较敏感。临床应根据药敏结果合理选择抗菌药物,减缓耐药菌的产生。

Objective To study the distribution of pathogens and drug resistance of hypertrophic adenoids and tonsils in children with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Adenoid and/or tonsil tissues from children with OSAHS diagnosed surgically from January 2013 to December 2017 were cultured for bacterial and fungal identification and drug sensitivity test.Results In this study,2631 children of3425 children were isolated 2916 pathogens in 5 years,the positive rate was 76.82%,among them,1639(56.21%)were Gram-positive cocci,743 strains of Staphylococcus aureus(25.48%),578 strains of Streptococcus pneumoniae(19.82%)and 241 strains of Streptococcus A(8.30%)were the main strains;1131 strains(38.79%)were Gram-negative,613 strains of Haemophilus influenzae(21.02%)and 141 strains of Pseudomonas aeruginosa(8.26%)were predominant.In the past five years,the species and proportion of pathogenic bacteria had not changed significantly.Vancomycin-resistant strains of Gram-positive cocci were not found in5 years.The resistance rate of Staphylococcus aureus to penicillins was over 90%,and the resistance rate to methicillin was on the rise(χ^2=12.36,P<0.05).Streptococcus pneumoniae was more than 80%resistant to clindamycin and erythromycin,and group A streptococcus was 100%sensitive to penicillins and cephalosporins,and more than 70%resistant to clindamycin,erythromycin,tetracycline and compound sulfamethoxazole.The resistance rate of Haemophilus influenzae to ampicillin showed an upward trend(χ^2=10.42,P<0.05),and the detection rate of beta-lactamase-producing strains showed an upward trend(χ^2=10.13,P<0.05).The resistance rate of Pseudomonas aeruginosa to carbapenems was low,but the resistance rate to ceftazidime,cefoperazone,piperacillin/tazobactam was increasing(χ^2=16.24,13.22,12.01,P<0.05).Conclusion Gram-positive cocci are the main infections of adenoids and tonsils in children with OSAHS.At present,the drug resistance situation of Staphylococcus aureus is serious.The resistance rates of Haemophilus influenzae and Pseudomonas aeruginosa to beta-lactamases are increasing,but most pathogens are still sensitive to carbapenems.Antibiotics should be reasonably selected according to the results of drug susceptibility to slow down the production of drug-resistant bacteria.