小儿细菌性肺炎痰培养物病原菌构成及耐药性分析

Composition and sensitivity of pathogenic bacteria in sputum culture of children with bacterial pneumonia

目的分析肺炎患儿痰培养物中细菌构成及其耐药情况,为小儿细菌性肺炎治疗提供合理使用抗感染药物的依据。方法对2019年11月至2020年12月济宁市第一人民医院临床送检的肺炎患儿痰液标本进行病原菌的分离鉴定和药敏试验,收集相关资料,并对小儿肺炎病原菌在临床上的分布特点及其耐药情况进一步分析。结果痰液培养阳性患儿183例,其中多重细菌感染患儿16例,共培养出199株细菌(剔除同一患儿的重复菌株),其中革兰阴性菌128株(64.32%),革兰阳性菌71株(35.68%)。主流细菌为肺炎链球菌(19.60%)、金黄色葡萄球菌(16.08%)、卡他莫拉菌(13.57%)、肺炎克雷伯菌(11.06%)和大肠埃希菌(10.05%)。多重细菌感染主要以金黄色葡萄球菌+肺炎克雷伯菌、金黄色葡萄球菌+大肠埃希菌混合为主(共5例,31.25%)。肺炎链球菌和金黄色葡萄球菌对利奈唑胺、万古霉素绝对敏感。卡他莫拉菌对头孢噻肟、头孢曲松、米诺环素等绝对敏感。肠杆菌科中肺炎克雷伯菌和大肠埃希菌药敏结果相似,对阿米卡星、厄他培南、头孢替坦敏感率在95%~100%,对氨苄西林耐药率在95%~100%。肺炎链球菌、金黄色葡萄球菌、卡他莫拉菌对左氧氟沙星敏感率均大于90%,大肠埃希菌、肺炎克雷伯菌对左氧氟沙星不够敏感,但中敏率达到75%以上。结论肺炎链球菌、金黄色葡萄球菌、卡他莫拉菌、肺炎克雷伯菌、大肠埃希菌感染是本地肺炎患儿痰液中常见菌,抗生素耐药状况比较严重,亚胺培南对革兰阴性菌混合感染的效果较好,利奈唑胺对阳性菌效果较好;左氧氟沙星可用于革兰阴性和阳性菌混合感染,合理使用抗生素应注意针对性和用药时间,杀灭致病菌的同时尽可能维护正常菌群的平衡。

Objective To analyze the composition and drug resistance of bacteria in sputum cultures of children with pneumonia, so as to provide the basis for rational use of anti-infection drugs in the treatment of bacterial pneumonia in children. Methods The pathogenic bacteria were isolated from the sputum samples of children with pneumonia sent for clinical examination in our hospital from November 2019 to December 2020. The relevant data were collected and the clinical distribution of pathogenic bacteria and their drug resistance were analyzed. Results A total of 183 children with positive sputum culture were enrolled, including 16 children with multiple bacterial infections. 199 bacterial strain(eliminating duplicate strains from the same patient) were cultured, including 128 Gram-negative bacteria(64.32%) and 71 Gram-positive bacteria(35.68%). The mainstream bacteria were Streptococcus pneumoniae(19.60%), Staphylococcus aureus(16.08%), Moraxella catarrhalis(13.57%), Klebsiella pneumoniae(11.06%) and Escherichia coli(10.05%). Multiple bacterial infections were mainly caused by the mixture of Staphylococcus aureus + Klebsiella pneumoniae and Staphylococcus aureus + Escherichia coli(5 cases, 31.25%). Streptococcus pneumoniae and Staphylococcus aureus were absolutely sensitive to Linezolid and Vancomycin. Moraxella catarrhalis was absolutely sensitive to Cefotaxime, Ceftriaxone, Minocycline and other antibiotics. The susceptibility results of Klebsiella pneumoniae and Escherichia coli in Enterobacteriaceae were similar;the susceptibility rates to Amikacin, Ertapenem and Cefotetan were 95%-100%, and the resistance rate to Ampicillin was 95%-100%. The susceptibility rates of Streptococcus pneumoniae, Staphylococcus aureus and Moraxella catarrhalis to Levofloxacin were more than 90%. Escherichia coli and Klebsiella pneumoniae were not sensitive to Levofloxacin, but the median sensitivity rate reached more than 75%. Conclusion Streptococcus pneumoniae, Staphylococcus aureus, Moraxella catarrhalis, Klebsiella pneumoniae and Escherichia coli are common bacteria in the sputa of local children with pneumonia, and their antibiotic resistances are high. Imipenem has good effect on mixed infection of Gram-negative bacteria, while Linezolid has good effect on positive bacteria. Levofloxacin can be used for mixed infections by Gram-negative and Gram-positive bacteria. Antibiotics should be used rationally to effectively kill pathogenic bacteria while maintaining the balance of the normal flora.