反复呼吸道感染患儿痰液标本中病原菌分布特征及耐药监测

Distribution characteristics and drug resistance monitoring of pathogens in sputum samples from children with recurrent respiratory tract infection

目的:探讨我院反复呼吸道感染(RRI)患儿痰液标本中病原菌分布特征及耐药情况,指导临床合理使用抗原菌。方法:选取2020年1月-2022年12月医院门诊96例RRI患儿作为本研究对象,采集呼吸道痰液和培养分离病原菌,对其进行药敏试验,统计和分析RRI患儿痰液标本中病原菌分布以及耐药情况。结果:96例RRI患儿的合格痰标本共分离出病原菌456株,其中革兰阳性菌146株(32.02%),以金黄色葡萄球菌(17.98%)和肺炎链球菌(6.80%)为主;革兰阴性菌203株(44.52%),以流感嗜血杆菌(21.05%)和大肠埃希菌(11.84%)为主;真菌107株(23.46%),以白色念珠菌(7.24%)和烟曲霉菌(6.58%)为主。革兰阳性菌中,金黄色葡萄球菌耐药性最高药物分别是青霉素G(98.78%)、氨苄西林(95.12%)和红霉素(90.24%);肺炎链球菌耐药性最高药物分别是青霉素G(90.32%)、红霉素(67.74%)和氨苄西林(54.84%),肺炎链球菌未对莫西沙星耐药。革兰阴性菌中,流感嗜血杆菌耐药性最高药物分别是氨苄西林(90.63%)、左氧氟沙星(79.17%)和头孢西林(77.08%);大肠埃希菌耐药性最高药物分别是氨苄西林(88.89%)、左氧氟沙星(77.78%)和头孢西林(68.52%)。真菌中,克柔念珠菌耐药性最高药物分别是制霉菌素(84.85%)、伊曲康唑(72.73%)和克霉唑(69.70%);光滑念珠菌耐药性最高药物分别是克霉唑(86.67%)、伏立康唑(80.00%)和制霉菌素(60.00%)。结论:革兰阴性菌是RRI患儿的主要感染病原菌,临床用药可根据药敏结果应用抗生素,加强耐药性的检测管理。

Objective:To explore the distribution characteristics and drug resistance of pathogens in sputum samples from children with recurrent respiratory tract infection(RRI)in the hospital so as to guide clinical rational use of antigenic bacteria.Methods:A total of 96 children with RRI in hospital outpatient were enrolled as the research objects between January 2020 and December 2022.The respiratory tract sputum was collected for culture and isolation of pathogens,and then pathogens were treated with drug susceptibility tests.The distribution and drug resistance of pathogens were statistically analyzed.Results:A total of 456 strains of pathogenic bacteria were isolated from the qualified sputum samples of 96 children with RRI,including 146 strains(32.02%)of gram-positive bacteria,mainly Staphylococcus aureus(17.98%)and Streptococcus pneumoniae(6.80%):There were 203 strains(44.52%)of gram-negative bacteria,mainly Haemophilus influenzae(21.05%)and Escherichia coli(11.84%).There were 107 strains of fungi(23.46%),mainly Candida albicans(724%)and Aspergillus fumigatus(6.58%):In gram-positive bacteria,drug resistance of S.aureus was higher to penicillin G(98.78%),ampicillin(95.12%)and erythromycin(90.24%),and drug resistance of S.pneumoniae was higher to penicillin G(90.32%),erythromycin(67.74%)and ampicillin(54.84%),but which was not resistant to moxifloxacin.In gram-negative bacteria,drug resistance of H.influenzae was higher to ampicillin(90.63%),levofloxacin(79.17%)and cefazolin(77.08%),and drug resistance of E.coli was higher to ampicillin(88.89%),levofloxacin(77.78%)and cefazolin(68.52%):In the fungi,drug resistance of Candida krusei was higher to nystatin(84.85%),itraconazole(72.73%)and clotrimazole(69.70%),and drug resistance of Candida glabrata was higher to clotrimazole(86.67%),voriconazole(80.00%)and nystatin(60.00%).Conclusion:Gram-negative bacteria are the main infection pathogens in children with RRI.In clinical medication,antibiotics can be applied according to the results of drug sensitivity,the detection and management of drug resistance should be strengthened.