院内儿科下呼吸道感染病原菌耐药性及临床用药分析

Analysis of drug resistance of pathogenic bacteria and clinical drug use of pediatric lower respiratory infection in hospital

目的分析院内儿科下呼吸道感染病原菌的种类、分布及耐药情况,探讨抗菌药物使用情况,以期为此病的临床治疗提供参考。方法选取2020年1月至2021年6月本院收治的100例下呼吸道感染患儿,对其痰液标本进行培养与分离,分析药敏试验结果及病原菌的耐药性,并探讨抗菌药物的实际使用情况。结果100例患儿中,共培养出病原菌18种,检出病原菌252株,其中革兰阴性菌占比为72.62%,革兰阳性菌占比为25.00%,真菌占比为2.38%。药敏试验结果显示,革兰阳性菌对红霉素、青霉素类具有高耐药性,即78.30%~100.00%;对头孢唑林、苯唑西林具有中等耐药性,即42.25%~67.95%;对万古霉素、林可霉素具有低耐药性,即0.00%~33.64%。革兰阴性菌对头孢噻肟钠、甲硝唑具有高耐药性,即5.15%~100.00%;对亚胺培南、头孢吡肟、头孢他啶、头孢哌酮/舒巴坦具有耐药性,即2.25%~44.76%。患儿共使用39种抗菌药物,其中应用率最高的是第3代头孢菌素类(30.77%)。在使用抗菌药物的患儿中,不良反应以上腹部不适发生率最高(4.00%)。结论院内儿科下呼吸道感染以革兰阴性菌为主,且呈多重耐药;在抗菌药物使用种类中,第3代头孢菌素类应用率最高。医院应根据病原菌耐药情况及时调整用药以提高治疗效果。

Objective To analyze the types,distribution and drug resistance of pathogenic bacteria of pediatric lower respiratory infection in hospital,and to explore the use of antibiotics,in order to provide reference for the clinical treatment of the disease.Methods A total of 100 children with lower respiratory infection treated in our hospital from January 2020 to June 2021 were selected.The sputum samples of the children were cultured and separated,the drug sensitivity test results and the drug resistance of pathogenic bacteria were analyzed,and the actual use of antibiotics was discussed.Results Among the 100 children,a total of 18 kinds of pathogenic bacteria were cultured and 252 strains of pathogenic bacteria were detected,among which Gram-negative bacteria accounted for 72.62%,Gram-positive bacteria accounted for 25.00%and fungi accounted for 2.38%.The drug sensitivity test results showed that Gram-positive bacteria had high resistance to erythromycin and penicillin,namely 78.30%-100.00%;it had moderate resistance to cefazolin and benzacillin,namely 42.25%-67.95%;it had low resistance to vancomycin and lincomycin,namely 0.00%-33.64%.Gram-negative bacteria had high resistance to cefotaxime sodium and metronidazole,namely 5.15%-100.00%;it had low resistance to imipenem,cefepime,ceftazidime,cefoperazone/sulbactam,namely 2.25%-44.77%.A total of 39 kinds of antibiotics were used in the children,among which the third-generation cephalosporins had the highest application rate(30.77%).Among the children using antibiotics,the incidence of abdominal discomfort in adverse reactions was the highest(4.00%).Conclusion Pediatric lower respiratory infection in hospital was mainly Gram-negative bacteria,and showed multiple drug resistance;among the types of antibiotics,the third-generation cephalosporins has the highest application rate.The hospital should adjust the medication in time according to the pathogenic bacteria drug resistance to improve the treatment effect.