儿童急性下呼吸道感染流感嗜血杆菌和肺炎链球菌检出情况及耐药性分析

Detection and drug resistance of Haemophilus influenzae and Streptococcus pneumoniae in children with acute lower respiratory tract infection

目的分析儿童下呼吸道感染流感嗜血杆菌(Hin)和肺炎链球菌(Spn)检出情况及其耐药情况,为合理利用抗菌药物提供有价值的临床参考。方法选取2018年1月—2020年12月中国科学院大学深圳医院(光明)西院区儿科收住院的急性下呼吸道感染Hin和Spn的患儿为研究对象,分析比较不同性别、年份和季节患儿的Hin和Spn检出率,并分析其耐药情况。结果3 342例下呼吸道感染患儿共检出细菌1 470株(43.98%),其中Hin占31.36%,男患儿占74.19%,女患儿占25.81%;Spn占19.12%(281/1 470),男患儿占66.19%,女患儿占33.81%;按年度统计其占细菌分离的比率,2018年度和2019年度比较接近,2020年度均大幅度下降,其中Hin的2019年度(49.67%)> 2018年度(42.08%)> 2020年度(8.24%),2季度(40.13%)> 1季度(36.44%)> 3季度(11.93%)>4季度(11.50%),Spn的2018年度(43.42%)> 2019年度(35.59%)> 2020年度(21.00%),2季度(30.25%)> 4季度(25.62%)> 1季度(24.91%)> 3季度(19.22%);细菌耐药情况:Hin对复方磺胺甲噁唑、氨苄西林、头孢丙烯、β-内酰胺酶的阳性率和头孢呋辛的耐药率比较高,均> 50%,分别为69.08%、63.46%、59.61%、51.61%和49.19%,对氯霉素、美洛培南、左旋氧氟沙星的耐药率比较低,均<5%分别为4.73%、2.39%和0.47%;Spn对红霉素、四环素和复方磺胺甲噁唑的耐药率比较高均> 50%,分别为97.54%、87.30%和56.19%,对氯霉素和阿莫西林的耐药率比较低,均<5%分别为2.81%和0.44%,而对青霉素、厄他培南、利奈唑胺、莫西沙星、泰利霉素、万古霉素和氧氟沙星均敏感。结论Hin和Spn均是患儿急性下呼吸道感染主要的分离细菌,男性患儿检出率高于女性患儿,均2季度感染量最高,均在抗疫的2020年度感染量下降明显;Hin和Spn对各类抗生素耐药性形势仍然十分严峻,头孢曲松可作为治疗儿童Hin感染的一线药物,阿莫西林可作为治疗儿童Spn感染的一线药物。

Objective To analyze the detection and drug resistance of Haemophilus influenzae( Hin) and Streptococcus pneumoniae( Spn) in children with lower respiratory tract infection,so as to provide valuable clinical reference for rational use of antibiotics. Methods Children with acute lower respiratory tract infection with Hin and Spn were selected from pediatrics in the University of Chinese Academy of Sciences Shenzhen Hospital( Guangming) West Hospital District from January2018 to December 2020. The detection rates of Hin and Spn in children with different gender,year and season were analyzed and compared,and their drug resistance was analyzed. Results 1470 strains of bacteria( 43. 98%) were detected in 3 342children with lower respiratory tract infection. Among them,Hin accounted for 31. 36%,male children accounted for74. 19%,and female children accounted for 25. 81%. Spn accounted for 19. 12%( 281/1 470),male children accounted for66. 19%,and female children accounted for 33. 81%. According to the annual statistics,the ratio of bacteria isolation in2018 is close to that in 2019,and both decreased significantly in 2020. Among them,Hin’ s 2019( 49. 67%) > 2018( 42. 08%) >2020( 8. 24%),Q2( 40. 13%) > Q1( 36. 44%) > Q3( 11. 93%) and Q4( 11. 50%). Spn’s 2018( 43. 42%) >2019( 35. 59%) > 2020( 21. 00%),Q2( 30. 25%) > Q4( 25. 62%) > Q1( 24. 91%) > Q3( 19. 22%). Bacterial drug resistance:The positive rates of compound sulfamethoxazole,ampicillin,cefprozil,β-lactamase and cefuroxime resistance of Hin were higher than 50%,which were 69. 08%,63. 46%,59. 61%,51. 61% and 49. 19% respectively. The resistance rates to chloramphenicol,meropenem and levofloxacin were relatively low,all less than 5%,4. 73%,2. 39% and 0. 47% respectively. The resistance rates of Spn to erythromycin,tetracycline and compound sulfamethoxazole were higher than 50%,97. 54%,87. 30% and 56. 19% respectively. The resistance rates to chloramphenicol and amoxicillin were relatively low,both less than 5%,2. 81% and 0. 44% respectively. It was sensitive to penicillin,ertapenem,linezolid,moxifloxacin,talimycin,vancomycin and ofloxacin. Conclusion Hin and Spn are the main isolated bacteria of acute lower respiratory tract infection in children. The detection rate of male children is higher than that of female children,and the infection volume is the highest in the second quarter,which has decreased significantly in 2020. The drug resistance of Hin and Spn to various antibiotics is still very serious. Ceftriaxone can be used as the first-line drug for the treatment of Hin infection in children,and amoxicillin can be used as the first-line drug for the treatment of Spn infection in children.