抚州市区小儿社区获得性下呼吸道感染主要病原菌分布、耐药性与年龄相关的研究

Correlation between distribution,antibiotic resistance and age of main pathogens of community-acquired lower respiratory tract infection in children in Fuzhou

目的探讨小儿社区获得性下呼吸道感染主要病原菌分布及耐药性与年龄的相关性,为7岁以下小儿获得性下呼吸道感染的预防及治疗提供依据。方法选取因患有社区获得性下呼吸道感染而就诊于抚州市妇幼保健院的小儿作为研究对象,采集其痰液标本进行病原菌培养与药敏试验分析,观察不同年龄段小儿社区获得性下呼吸道感染主要病原菌分布及耐药性的分布情况。结果共分离出病原菌314株,排名前5位的主要病原菌分别为肺炎链球菌(占30.6%)、肺炎克雷伯菌(占21.3%)、大肠埃希菌(占15.6%)、流感嗜血杆菌(占15.3%)、铜绿假单胞菌(占5.7%);其新生儿期主要以大肠埃希菌和肺炎克雷伯菌为主,婴儿期主要以肺炎链球菌和肺炎克雷伯菌为主,幼儿期和学龄前期均主要以肺炎链球菌为主,5种主要病原菌均主要分布于婴儿期,且5种主要病原菌的分离率在≤28d、29d~1岁、1~3岁、3~7岁患儿间比较差异具有统计学意义(χ^(2)=57.92,P=0.000<0.05);肺炎链球菌对红霉素、克林霉素、头孢呋辛和四环素耐药率均>75%,对复方新诺明耐药率>38%,对青霉素、阿莫西林/克拉维酸、头孢曲松、美罗培南、左氧氟沙星、万古霉素、利奈唑胺有较强敏感性(耐药率<7.7%);肺炎克雷伯菌除幼儿期和学龄前期的各1例外,其他对头孢呋辛、头孢西丁、复方新诺明、氯霉素有一定的耐药性(10%≤耐药率≤30%),对头孢他啶、头孢吡肟、β-内酰胺合剂、碳青霉烯类、氨基糖苷类、喹诺酮类敏感性极强(耐药率≤10%);大肠埃希菌除幼儿期和学龄前期各1例外,其他对氨苄西林有极强耐药性(耐药率>78%),对头孢菌素类、喹诺酮类、复方新诺明、庆大霉素、氯霉素有较强的耐药性(7%<耐药率<71%),对β-内酰胺合剂、亚胺培南、美罗培南、阿米卡星敏感性极强(耐药率<7.1%);流感嗜血杆菌对哌拉西林/他唑巴坦、阿莫西林/克拉维酸、头孢他啶、头孢噻肟、美罗培南、阿奇霉素、左氧氟沙星有极强敏感性(耐药率为<7.5%),除幼儿期2例外,其他对氨苄西林、头孢呋辛、复方新诺明有较强耐药性(>27%);铜绿假单胞菌除婴儿期1例对哌拉西林、头孢他啶、哌拉西林/他唑巴坦、替卡西林/克拉维酸耐药率为10.0%,其他对各抗菌药物均有极强敏感性(耐药率为0%)。结论7岁以下小儿社区获得性下呼吸道感染主要病原菌分布及耐药性具有年龄差异,儿科临床治疗中应依据药敏试验结果选择合适的抗菌药物,增加针对性用药率,减少经验性或预防性抗生素使用情况,以减少本地区耐药菌株出现。

Objective To explore the correlation between distribution,antibiotic resistance and age of main pathogens of community-acquired lower respiratory tract infection in children in Fuzhou,providing the theoretical basis for the prevention and treatment in children under 7 years old.Methods Children with community-acquired lower respiratory tract infection in Fuzhou Maternal and Child Health Hospital were selected as the research objects,and their sputum samples were collected for pathogen culture and antibiotic sensitivity test.The distribution and antibiotic resistance of the pathogenic bacteria in different age groups were collected and analyzed.Results A total of 314 strains of pathogenic bacteria were isolated,and the top five were Streptococcus pneumoniae(30.6%),Klebsiella pneumoniae(21.3%),Escherichia coli(15.6%),Haemophilus influenzae(15.3%),and Pseudomonas aeruginosa(5.7%).Escherichia coli and Klebsiella pneumoniae were the main pathogenic bacteria in neonatal period,Streptococcus pneumoniae and Klebsiella pneumoniae were the main pathogenic bacteria in babyhood,and Streptococcus pneumoniae were the main pathogenic bacteria in infancy and pre-school age.The five main pathogenic bacteria were mainly distributed in infancy,and their isolation rates among pediatric patients≤28 days,29 days to 1 year old,1-3 years old and 3-7 years old were statistically significant(χ^(2)=57.92,P=0.000<0.05).The resistance rate of Streptococcus pneumoniae to erythromycin,clindamycin,cefuroxime and tetracycline was more than 75%,the resistance rate to compound sulfamethoxazole was more than 38%,and it had strong sensitivity to penicillin,amoxicillin/clavulanic acid,ceftriaxone,meropenem,levofloxacin,vancomycin and linezolid(the resistance rate was less than 7.7%).Except for one case in infancy and one in preschool period,other Klebsiella pneumoniae was resistant to cefuroxime,cefoxitin,compound sulfamethoxazole and chloramphenicol(10%≤drug resistance rate≤30%),had a strong sensitivity to ceftazidime,cefepime,β-lactam mixture,carbapenems,aminoglycosides,quinolones(drug resistance rate≤10%).Except for one case in infancy and one in preschool period,other Escherichia coli had very strong drug resistance rate to ampicillin(drug resistance rate>78%),had a strong resistance rate to cephalosporins,quinolones,compound sulfamethoxazole,gentamicin and chloramphenicol(7%<drug resistance rate<71%),had a high sensitivity toβ-lactam mixture,imipenem,meropenem,amikacin(drug resistance rate<7.1%).Haemophilus influenzae was highly sensitive to piperacillin/tazobactam,amoxicillin/clavulanic acid,ceftazidime,cefotaxime,meropenem,azithromycin and levofloxacin(drug resistance rate<7.5%),except for 2 cases infancy,other Haemophilus influenzae had strong drug resistance rate to ampicillin,cefuroxime and compound sulfamethoxazole(>27%).The drug resistance rate of Pseudomonas aeruginosa to piperacillin,ceftazidime,piperacillin/tazobactam,ticarcillin/clavulanic acid was 10.0%in one case in babyhood,the others were highly sensitive to all kinds of antibiotics(drug resistance rate was 0%).Conclusion The distribution and Antibiotic Resistance of main pathogenic bacteria of community-acquired lower respiratory tract infection in children under 7 years old has great difference in age.In clinical treatment of pediatrics,appropriate antibiotics should be selected according to drug sensitive test.In addition,the use of targeted antibiotics rate should be encouraged,while the use of empirical or prophylactic antibiotics should be eliminated to reduce the occurrence of drug-resistant strains in this area.