反复下呼吸道感染患儿罹患细菌性下呼吸道感染的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing lower respiratory tract infections in children with recurrent respiratory tract infection

目的:探讨儿童反复呼吸道感染(recurrent respiratory tract infection,RRTI)罹患细菌性下呼吸道感染的病原菌分布及耐药率特点。方法:回顾收集同期收治的RRTI和非RRTI罹患细菌性下呼吸道感染者为RRTI组和非RRTI组(每组各150例),对比2组患者的病原菌分布及耐药性差异。结果:RRTI组病原菌以G-菌为主(63.39%),以肺炎克雷伯菌、铜绿假单胞菌和金黄色葡萄球菌常见;非RRTI组病原菌以G+菌为主(55.35%),以金黄色葡萄球菌、肺炎链球菌和肺炎克雷伯菌常见。RRTI组混合感染率(18.67%)显著大于非RRTI组(6.00%)。RRTI组G+菌对阿莫西林克拉维酸钾、头孢曲松和庆大霉素的耐药率<35%。非RRTI组G+菌对头孢唑林、庆大霉素的耐药率<35%,对阿莫西林克拉维酸钾、头孢曲松的耐药率<20%。RRTI组G-菌对哌拉西林钠他唑巴坦钠、头孢哌酮钠舒巴坦的耐药率<35%。非RRTI组G-菌对哌拉西林钠他唑巴坦钠、头孢吡肟、阿米卡星的耐药率<35%,对头孢哌酮钠舒巴坦的耐药率<20%。结论:RRTI组和非RRTI组患者下呼吸道感染病原菌分布、细菌耐药性均存在差异,临床医师应了解患者RRTI病史,了解病原菌分布及耐药率情况,正确合理应用抗菌药物。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing lower respiratory tract infections in children with recurrent respiratory tract infection(RRTI).METHODS RRTI patients and non-RRTI patients with lower respiratory tract infections with concurrent admission as RRTI group and non-RRTI group(150 patients in each group)were retrospective studied,and the pathogen distribution and drug resistance of the two groups were compared.RESULTS The main pathogens in RRTI group were Gram-negative(G-)bacteria(63.39%),and Klebsiella pneumoniae,Pseudomonas aeruginosa and Staphylococcus aureus were common,and those in non-RRTI group were Gram-positive(G+)bacteria(55.35%),and Staphylococcus aureus,Streptococcus pneumoniae and Klebsiella pneumoniae were common.The mixed infection rate of RRTI group(18.67%)was significantly higher than that of non-RRTI group(6.00%).In RRTI group,the drug resistance rates of G+bacteria to amoxicillin/clavulanate potassium,ceftriaxone and gentamicin were less than 35%,and in non-RRTI group,the drug resistance rates of G+bacteria to cefazolin and gentamicin were less than 35%,and the resistant rates to amoxicillin clavulanate potassium and ceftriaxone were less than 20%.In RRTI group,the drug resistance rates of G-bacteria to piperacillin/tazobactam and cefoperazone/sulbactam were less than 35%.In non-RRTI group,the drug resistance rates of G-bacteria to piperacillin/tazobactam,cefepime and amikacin were less than 35%,and the resistance rate to cefoperazone/sulbactam was less than 20%.CONCLUSION There are differences in the distribution and drug resistance of bacteria between RRTI and non-RRTI patients.Clinicians should understand the RRTI history,distribution of pathogens and drug resistance of patients in order to use antibiotics correctly.