反复呼吸道感染患儿病原菌分布与耐药性分析

Distribution and drug resistance of pathogens in children with recurrent respiratory tract infection

目的探讨反复呼吸道感染患儿的病原菌分布情况与耐药性。方法对东莞市中医院2017年2月至2019年7月收治的60例反复呼吸道感染患儿的呼吸道分泌物进行病原菌培养鉴定以及药敏试验,统计分析其病原菌分布及细菌耐药情况。结果 60例患儿共检出病原菌388株,其中革兰阳性菌153株(39.43%):金黄色葡萄球菌79株(20.36%)、肺炎链球菌24株(6.19%),表皮葡萄胎球菌19株(4.90%);革兰阴性菌235株(60.56%):流感嗜血杆菌99株(25.52%)、大肠埃希菌55株(14.18%)、铜绿假单胞菌31株(7.99%);革兰阳性菌中,金黄色葡萄球菌耐药性最高者依次为青霉素G (100.00%)、氨苄西林(79.95%)、红霉素(73.41%),肺炎链球菌耐药率最高者依次为青霉素G (91.67%)、红霉素(79.17%)、克林霉素(75.00%)、氨苄西林(70.83%),金黄色葡萄球菌与肺炎链球菌均未对呋喃妥因及万古霉素耐药;革兰阴性菌中,流感嗜血杆菌耐药性最高者依次为头孢他啶(79.80%)、左氧氟沙星(70.70%)、氨苄西林(69.70%)、头孢克洛(68.69%);大肠埃希菌耐药率最高者依次为氨苄西林(90.90%)、头孢呋辛(89.09%)、头孢他啶(83.63%)、头孢唑林(81.82%);铜绿假单胞菌耐药率最高者依次为氨苄西林(61.29%)、头孢他啶(61.29%);革兰阴性菌对头孢哌酮钠舒巴坦钠、亚胺培南、阿米卡星均较敏感,耐药率均小于25.00%。结论反复呼吸道感染患儿主要感染病原菌为革兰阴性菌,临床用药应根据病原菌分布情况及耐药性合理选择抗菌药物,减少抗菌药物滥用情况。

Objective To analyze the distribution and drug resistance of pathogens in children with recurrence respiratory tract infection(RRI). Methods Bacterial culture and drug sensitivity test were carried out in 60 patients with recurrent respiratory tract infection, who admitted to Dongguan Hospital of Traditional Chinese Medicine during February 2017 and July 2019, and the distribution and drug resistance of pathogens were analyzed. Results A total of388 strains of pathogenic bacteria were detected in 60 children, including 153 strains of Gram-positive bacteria(39.43%): 79 strains of Staphylococcus aureus(20.36%), 24 strains of Streptococcus pneumoniae(6.19%), 19 strains of Staphylococcus epidermidis(4.90%);235 strains of Gram-negative bacteria(60.56%): 99 strains of Haemophilus influenzae(25.52%), 55 strains of Escherichia coli(14.18%), 31 strains of Pseudomonas aeruginosa(7.99%). Among Gram-positive bacteria, Staphylococcus aureus were the most resistant to penicillin G(100.00%), ampicillin(79.95%), erythromycin(73.41%), Streptococcus pneumoniae were the most resistant to penicillin G(91.67%), erythromycin(79.17%), clindamycin(75.00%), ampicillin(70.83%), while Staphylococcus aureus and Streptococcus pneumoniae were not resistant to furantoin or vancomycin;Among Gram-negative bacteria, Haemophilus influenzae were the most resistant to ceftazidime(79.80%), levofloxacin(70.70%), ampicillin(69.70%), cefaclor(68.69%);Escherichia coli were the most resistant to ampicillin(90.90%), cefuroxime(89.09%), ceftazidime(83.63%), cefazolin(81.82%);Pseudomonas aeruginosa were most resistant to ampicillin(61.29%) and ceftazidime(61.29%). Gram-negative bacteria were sensitive to cefoperazone sodium, sulbactam sodium, imipenem and amikacin, and the drug resistance rate was less than 25.00%. Conclusion The main pathogens of RRI children are Gram-negative bacteria. Antibiotics should be selected reasonably according to the distribution of pathogens and drug resistance characteristics to reduce the abuse of antibiotics. Attention should be paid to improve the rational use of antibiotics in the treatment of RRI children.