某地区20328例儿童下呼吸道感染病原菌分布及耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria in 20328 children with lower respiratory tract infection in a region

目的探析临沂地区儿童下呼吸道感染病原菌分布及细菌耐药性,为该地区儿科抗感染治疗提供科学依据。方法回顾2019年1月至2022年12月该院儿科诊断为下呼吸道感染的20328例患儿送检的痰及支气管肺泡灌洗液标本,进行细菌培养、分离鉴定和体外药敏试验,统计儿童下呼吸道感染病原菌分布及其药物敏感性。结果临床送检的20328份下呼吸道标本中分离出致病菌6255株,阳性率为30.77%。其中革兰氏阴性菌占54.96%(3438/6255),以流感嗜血杆菌和卡他布兰汉菌为主;革兰氏阳性菌占45.04%(2817/6255),以肺炎链球菌和金黄色葡萄球菌为主。主要致病菌肺炎链球菌和流感嗜血杆菌的检出具有明显的季节性和年龄差异有统计学意义(P<0.05)。药敏结果显示:产β内酰胺酶的流感嗜血杆菌和卡他布兰汉菌检出率分别为76.2%和100%,且对氨苄西林和复方磺胺甲噁唑耐药率较高,未检出对头孢曲松耐药的菌株;肺炎链球菌对红霉素和克林霉素的耐药率超过了99.0%,对四环素的耐药率也在90%以上,对复方磺胺甲噁唑的耐药率为86.60%;金黄色葡萄球菌对青霉素G耐药率为99.02%,未检出肺炎链球菌和金黄色葡萄球菌对万古霉素和利奈唑胺耐药或中介的菌株。结论临沂地区儿童下呼吸道感染的病原菌以肺炎链球菌和流感嗜血杆菌为主,在不同年龄段及不同季节检出率具有显著性差异;不同细菌对抗菌药物的敏感性不同,临床在医治过程中,应当及时送检培养,根据培养结果合理使用抗菌药物。

Objective To investigate the pathogen distribution and bacterial resistance of lower respiratory tract infection in the hospital,and to provide the basis for pediatric anti-infective treatment.Methods The results of bacterial culture,identification and drug sensitivity test of sputum and bronchoalveolar lavage fluid samples submitted from 20,328 hospitalized children diagnosed with lower respiratory tract infection in the hospital from January 2019 to December 2022 were reviewed,and the bacterial distribution and drug resistance of lower respiratory tract infection in children were statistically analyzed.Results Total of 6255 pathogenic bacteria were isolated from 20,328 samples,including 3438 Gram-negative bacterias(54.96%),mainly Haemophilus influenzae,Branhamella catarrhalis,and 2817 Gram-positive bacterias(45.04%),mainly Streptococcus pneumoniae and Staphylococcus aureus.Streptococcus pneumoniae and Haemophilus influenzae showed significant seasonal differences(P<0.05).The detection rate was highest in winter,followed by spring and lowest in summer.The detection rates of Haemophilus influenzae and catarbranchella producingβ-lactamase were 76.2%and 100%,respectively,and the resistance rates to ampicillin and cotrimoxazole were highe.No ceftriaxone resistant strains were detected.The resistance rate of Streptococcus pneumoniae to erythromycin and clindamycin was more than 99.0%,the resistance rate od Streptococcus pneumoniae to tetracycline was more than 90%,and the resistance rate of Streptococcus pneumoniae to cotrimoxazole was 86.60%.The resistance rate of Staphylococcus aureus to penicillin G was 99.02%.No Streptococcus pneumoniae and Staphylococcus aureus were resistant to vancomycin and linezolid.Conclusion Streptococcus pneumoniae and Haemophilus influenzae were the major pathogens of children′s lower respiratory tract infection in Linyi area.Different bacterias havedifferent sensitivities to antibiotics.Specimen should be timely sent for examination and culture,andwe should pay more attention to rational use of antibacterial drugs according to bacterial culture results.