儿童下呼吸道感染细菌的流行特征及耐药性分析

Epidemic characteristics and drug resistance analysis of bacteria in lower respiratory tract infection in children

目的分析儿童下呼吸道感染细菌的流行特征及耐药性,为临床经验性诊治提供参考依据。方法回顾并分析南华大学附属第二医院2019年1月1日—2021年12月31日收治呼吸道感染患儿的细菌(除外肺炎支原体)检出情况、季节变化规律以及年龄分布,对重点细菌的耐药性进行分析。结果共检出细菌2267株,其中革兰阳性(G^(+))菌1133株,占比为50.0%;革兰阴性(G^(-))菌1114株,占比为49.1%;真菌20株,占比为0.9%。检出率排名在前五位的细菌依次为肺炎链球菌(759株)、流感嗜血杆菌(450株)、金黄色葡萄球菌(352株)、卡他莫拉菌(232株)、肺炎克雷伯菌(136株)。细菌感染以冬季和春季为主要流行季节,且好发于婴幼儿期。细菌耐药性监测结果显示,肺炎链球菌对青霉素的耐药率为0.4%,耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为20.9%,产超广谱β-内酰胺酶(ESBL)的肺炎克雷伯菌检出率为36.0%。同时,β-内酰胺酶阳性的流感嗜血杆菌和卡他莫拉菌检出率分别为59.8%和97.8%。结论儿童下呼吸道病原菌的耐药情况比较严峻,其中细菌感染以肺炎链球菌和流感嗜血杆菌为主,冬季和春季为高发期,0~3岁儿童为高发人群,家庭护理和临床诊疗应尤其注意上述特征。

Objective To analyze the epidemiological characteristics of bacteria in children with lower respiratory tract infection,and to provide reference for clinical empirical diagnosis and treatment.Methods The bacterial detection(excluding Mycoplasma pneumoniae),seasonal variation patterns,age distribution,and antibiotic resistance analysis of key bacteria in children with respiratory infection at the Second Affiliated Hospital of South China University from January 1,2019 to December 31,2021 were reviewed and analyzed.Results A total of 2267 strains of bacteria were detected,including 1133 strains of Gram positive(G^(+))bacteria(accounting for 50.0%),1114 strains of Gram negative(G^(-))bacteria(accounting for 49.1%),and 20 strains of fungi(accounting for 0.9%).The top five bacteria in the detectable rate were 759 strains of Streptococcus pneumoniae,450 strains of Haemophilus influenzae,352 strains of Staphylococcus aureus,232 strains of Moraxella catalae and 136 strains of Klebsiella pneumoniae.Bacterial infection was mainly prevalent in winter and spring,and was more common in infants and young children.Bacterial drug resistance monitoring showed that the resistance rate of Streptococcus pneumoniae to Penicillin was 0.4%,the detectable rate of Methicillin resistant Staphylococcus aureus(MRSA)was 20.9%,the detectable rate of extended spectrumβ-lactamases(ESBL)producing Klebsiella pneumoniae was 36.0%,the detectable rates ofβ-lactamase positive Haemophilus influenzae and Moraxella cataratha were 60.1%and 99.3%,respectively.Conclusions The antimicrobial resistance of pathogenic bacteria in respiratory tract infection of children is on the rise in the bacterial pathogens isolated from children,and the bacterial infection is mainly Streptococcus pneumoniae and Haemophilus influenzae.Winter and spring are the high incidence periods,and 0-3 years old children were the high incidence group.The above characteristics should be paid special attention to in family nursing,clinical diagnosis and treatment.