通过支气管肺泡灌洗液分析儿童重症肺炎的病原菌分布与耐药情况

Analysis of bacterial distribution and antibiotic resistance in children with severe pneumonia through bronchoalveolar lavage fluid

目的了解本地区儿童重症肺炎的病原菌分布及耐药情况。方法2018年4月至2020年3月在甘肃省人民医院确诊的203例重症肺炎患儿分为0~1岁、1~3岁、3~7岁和7~14岁组,对支气管肺泡灌洗液进行细菌培养和鉴定,并做抗生素敏感性试验。结果病原菌阳性率69.5%(141/203),其中革兰阴性菌72.3%(102株),革兰阳性菌30.5%(43株)。细菌感染率以0~1岁组最高,7~14岁组最低,分别为45.2%(19/42)和16.9%(10/59)。1~3岁组患儿的流感嗜血杆菌、大肠杆菌和卡他布兰汉菌的感染率最高,分别为30.30%(10/33)、33.33%(11/33)和21.21%(7/33),与其余年龄组比较差异有统计学意义(P<0.05)。0~1岁组患儿的肺炎链球菌感染率为42.9%(18/42),与其余组比较差异有统计学意义(P<0.001)。流感嗜血杆菌对甲氧苄啶/磺胺甲恶唑的耐药率为89.5%(34/38)。肺炎链球菌对甲氧苄啶/磺胺甲恶唑和四环素的耐药率均为82.4%(28/34)。大肠埃希菌的耐药率最高为34.6%(9/26),卡他布兰汉菌对克林霉素的耐药率为56.3%(9/16)。结论本地区儿童重症肺炎的优势病原菌依次是流感嗜血杆菌、肺炎链球菌、大肠杆菌和卡他布兰汉菌,细菌感染率以1岁以下儿童最高,随着年龄的增长而逐渐下降。流感嗜血杆菌和肺炎链球菌存在较严峻的耐药性。

Objective To realize the bacterial distribution and antibiotic resistance in children with severe pneumonia in this region.Methods A total of 203 children with severe pneumonia diagnosed in Gansu Provincial People′s Hospital from April 2018 to March 2020 were divided into 0-1,1-3,3-7 and 7-14 years old groups.Bronchoalveolar lavage fluid was collected for bacterial culture and identification,and antibiotic susceptibility tests were performed.Results The positive rate of pathogens was 69.5%(141/203),including 72.3%(102 strains)of Gram-negative bacteria and 30.5%(43 strains)of Gram-positive bacteria.The infection rates were highest in 0-1 years old group and the lowest in 7-14 years old group,which were 45.2%(19/42)and 16.9%(10/59),respectively.The infection rates of Haemophilus influenzae,Escherichia coli and Branhamella catarrhalis in the 1-3 years old group were 30.30%(10/33),33.33%(11/33),and 21.21%(7/33),respectively,which showed significant differences compared with other groups(P<0.05).The infection rate of Streptococcus pneumoniae in the 0-1 years old group was 42.9%(18/42),which was significantly different compared with other groups(P<0.001).The resistance rate of Haemophilus influenzae to trimethoprim/sulfamethoxazole was 89.5%(34/38),and the Streptococcus pneumoniae to trimethoprim/sulfamethoxazole and tetracycline were both 82.4%(28/34).The highest antibiotic resistance rate of Escherichia coli was 34.6%(9/26),and the Branhamella catarrhalis to clindamycin was 56.3%(9/16).Conclusion The dominant bacteria for severe pneumonia in children are Haemophilus influenzae,Streptococcus pneumoniae,Escherichia coli and Branhamella catarrhalis.The bacterial infection rate is highest within 1 year old,but gradually decreases with the increase of age.Haemophilus influenzae and Streptococcus pneumoniae have severe resistance to several antibiotics.