病原菌检测在急性呼吸系统感染性疾病患儿中的应用价值

Clinical application value of pathogenic bacteria detection in children with acute respiratory infection disease

目的探讨该院前5位急性呼吸系统感染性疾病(肺炎、急性支气管炎、急性扁桃体炎、急性喉炎、急性咽峡炎)住院患儿培养出的细菌构成、耐药菌现状及变化趋势,以指导临床合理使用抗菌药物。方法收集2015-2019年该院收治的前5位急性呼吸系统感染性疾病患儿的痰液、咽拭子、血液、脓液4类标本,共27222份,分离病原菌并进行药敏试验,采用全自动VITEK2-Compact和半自动ATB-express微生物鉴定和药敏分析系统对分离菌株进行细菌鉴定,参照2012年美国临床和实验室标准化协会(CLSI)推荐的药敏试验方法进行药敏试验。将培养出的致病菌种类及耐药情况进行归纳整理,分析其变化趋势。结果共送检痰液、咽拭子、血液、脓液标本27222份。培养出病原菌7233株,分离出菌株18种,前5位的急性呼吸系统感染性疾病依次为肺炎、急性支气管炎、急性扁桃体炎、急性喉炎、急性咽峡炎,其中肺炎为4665例(64.50%);培养出的前4位菌株依次为流感嗜血杆菌、卡他布兰汉菌、肺炎链球菌、金黄色葡萄球菌,其中耐药菌占32.87%(2267株);在前4位的耐药菌中肺炎链球菌占58.93%(1336株)。结论该院前5位儿童急性呼吸系统感染性疾病患儿标本培养菌株阳性率与分离菌株耐药性均呈逐年上升趋势,且患儿年龄越小,细菌培养阳性率越高,肺炎患儿标本培养出菌株数最多,所有培养出的菌株流感嗜血杆菌居第1位,耐药菌株中肺炎链球菌占首位。

Objective To investigate the bacterial composition,current situation and trend of drug-resistant bacteria cultured from children with the top five acute respiratory infection diseases(pneumonia,acute bronchitis,acute tonsillitis,acute laryngitis and acute pharyngitis)hospitalized in Chengdu Children Specialized Hospital,so as to guide the rational use of antibiotics.Methods The samples of sputum,pharyngeal swabs,blood and pus of 27222 children with acute respiratory infection diseases admitted in Chengdu Children Specialized Hospital from 2015 to 2019 were collected to isolate pathogenic bacteria and conducted drug sensitivity test.The bacteria were identified by VITEK2-Compact,semi-automatic ATB-Express methods drug sensitivity system.The drug sensitivity test was performed according to the 2012 CLSI recommended drug sensitivity test method.The species of pathogenic bacteria and the situation of drug resistant bacteria were summarized and sorted out to analyze their changing trend.Results A total of 27222 sputum,throat swab,blood and pus specimens were examined.In the 7233 strains,18 strains were isolated,and the top five cases of acute respiratory infection diseases were pneumonia,acute bronchitis,acute tonsillitis,acute laryngitis and acute pharyngitis,among which 4665(64.50%)were pneumonia.The top 4 strains were Haemophilus influenzae,Branhamellacatarrhalis,Streptococcus pneumoniae and Staphylococcus aureus,among which drug-resistant bacteria were 32.87%(2267 strains).Streptococcus pneumoniae accounted for 58.93%(1336 strains)of the top 4 drug-resistant strains.Conclusion Its top five specimens of children with acute respiratory infection disease in children microbe cultivated strains and resistance isolates showed a trend of rising year by year,and the bacteria detection rate of children is higher,pneumonia cultivated strains most cases,all produce strain of Haemophilus influenzae for first,drug-resistant strains of Streptococcus pneumoniae accounted for first place.