十堰地区婴幼儿社区获得性肺炎常见病原体致病情况及耐药性变迁分析

Pathogenicity and drug resistance changes of common pathogens of infant community acquired pneumonia in Shiyan area

目的分析十堰地区婴幼儿社区获得性肺炎(CAP)常见病原体致病情况及耐药性的变迁。方法选取2018年2月至2019年2月十堰区多家医院收治的1282例CAP患儿,采集所有患儿深部痰液标本,对痰液中细菌菌种进行鉴定,采用MIC法进行药敏试验,并分析检出细菌对常用抗菌药物的耐药情况。结果282例CAP患儿中病原体检出阳性者684例(53.35%),其中肺炎链球菌检出146例(21.35%),肺炎链球菌、大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、产气肠杆菌、阴沟肠杆菌在年龄≤12个月的患儿中检出率明显高于年龄12~36个月的患儿(均P<0.05)。1282例患儿肺炎支原体检出率为6.16%(79/1282),肺炎衣原体检出率为11.39%(146/1282),肺炎支原体/衣原体在年龄12~36个月的患儿中检出率分别为13.71%(51/372)、25.81%(96/372)明显高于年龄≤12个月患儿的3.08%(28/910)、5.49%(50/910)(P<0.05)。在革兰氏阳性菌中,肺炎链球菌对红霉素、四环素、克林霉素耐药率均>80%,金黄色葡萄球菌对青霉素、红霉素、克林霉素、氨苄西林耐药率均>50%;肺炎链球菌和金黄色葡萄球菌对万古霉素、利奈唑胺均敏感。在革兰氏阴性菌中,大肠埃希菌和肺炎克雷伯菌均对头孢唑林、头孢他啶、头孢吡肟、头孢曲松、氨苄西林、氨曲南耐药率>70%;流感嗜血杆菌对氨苄西林耐药率最高;铜绿假单胞菌对头孢曲松、头孢替坦均100%耐药;革兰氏阳性菌对哌拉西林及阿米卡星耐药率最低。结论十堰地区婴幼儿社区获得性肺炎常见病原体为肺炎链球菌,主要对红霉素、四环素、克林霉素耐药率均较高,临床应当使用敏感抗菌素提高治疗效率。

Objective To analyze the pathogenicity and drug resistance changes of common pathogensof infant community acquired pneumonia in Shiyan area. Methods 1 282 children with cap admitted to manyhospitals in Shiyan district from February 2018 to February 2019 were selected to collect the deep sputumsamples of all children, identify the bacterial species in the sputum, carry out the drug sensitivity test with MICmethod, and detect the resistance of the bacteria detected to the commonly used antibiotics. Results in 282children with cap, 684 (53.35%) were positive in physical examination, of which 146 (21.35%) were positivein Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacteraerogenes and Enterobacter cloacae (P<0.05). The detection rates of Mycoplasma pneumoniae and Chlamydiapneumoniae were 6. 16% (79/1 282) and 11. 39% (146/1 282), respectively. The detection rates ofMycoplasma pneumoniae and Chlamydia pneumoniae in children aged 12⁃36 months were 13.71% (51/372)and 25.81% (96/372), respectively, which were significantly higher than 3.08% (28/910) and 5.49% (50/910) of children with age ≤12 months (all P<0.05). Among Gram⁃positive bacteria, the resistance rate ofStreptococcus pneumoniae to erythromycin, tetracycline and clindamycin was more than 80%, that of Staphylococcus aureus to penicillin, erythromycin, clindamycin and ampicillin was more than 50%, and that ofStreptococcus pneumoniae and Staphylococcus aureus to vancomycin and linezolid. Among Gram⁃negativebacteria, Escherichia coli and Klebsiella pneumoniae were resistant to cefazolin, ceftazidime, cefepime,ceftriaxone, ampicillin, and aztreonam more than 70%;Haemophilus influenzae was resistant to ampicillin thehighest;Pseudomonas aeruginosa was resistant to ceftriaxone and cefotetan 100%;Gram⁃positive bacteria wereresistant to piperacillin and amikacin the lowest. Conclusion Streptococcus pneumoniae is the commonpathogen of infant community acquired pneumonia in Shiyan area, which is resistant to erythromycin,tetracycline and clindamycin. Sensitive antibiotics should be used to improve the treatment efficiency.