408例5岁以下儿童肺炎流行病学特点及病原菌分布、耐药情况分析

Epidemiological characteristics,pathogenic bacteria distribution and drug resistance of pneumonia in 408 children under 5 years old

目的分析儿童肺炎的流行病学特征、病原菌分布及药敏试验结果,为临床儿童肺炎的防治、临床合理用药提供参考。方法回顾性收集2021年11月—2023年6月成都市郫都区妇幼保健院、成都市妇女儿童中心医院收治的408例5岁以下细菌性肺炎患儿的临床资料、痰培养结果及病原菌药敏结果,描述性分析不同年龄段、性别常见病原菌检出情况以及病原菌的耐药情况。结果408例肺炎患儿中,检出1种病原菌感染368例(90.20%),检出2种及以上病原菌感染40例(9.80%)。送检的痰标本中共检出468株病原菌,其中革兰氏阳性菌165株(35.26%),革兰氏阴性菌303株(64.74%)。检出病原菌以肺炎链球菌(31.41%)、流感嗜血杆菌(24.79%)、卡他莫拉菌(19.02%)、草绿色链球菌(15.81%)和金黄色葡萄球菌(3.85%)为主,不同性别患儿的5种主要病原菌检出率比较,差异均无统计学意义(P>0.05)。1~3岁、>3~5岁患儿肺炎链球菌检出率高于<1岁患儿,而流感嗜血杆菌、金黄色葡萄球菌检出率低于<1岁患儿(P<0.05)。冬季肺炎链球菌检出率高于秋季,春季流感嗜血杆菌检出率高于夏、秋和冬季(P<0.05)。肺炎链球菌、卡他莫拉菌对复方新诺明耐药率最高,耐药率分别为53.74%、22.47%;流感嗜血杆菌、金黄色葡萄球菌对氨苄西林耐药率最高,耐药率分别为67.24%、83.33%;草绿色链球菌对氨苄西林、头孢曲松耐药率最高,耐药率均为51.35%。结论该地区儿童肺炎的感染病原菌以肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、草绿色链球菌和金黄色葡萄球菌为主,不同年龄段、不同季节病原菌感染分布存在差异;临床应根据病原菌耐药特点合理选用敏感抗菌药物。

Objective To analyze the epidemiological features,pathogenic bacteria distribution and drug sensitivity test results of pneumonia in children,and to provide references for prevention and treatment of pneumonia in children as well as rational drug use in clinical practice.Methods We retrospectively collected the clinical data,sputum culture results and drug sensitivity test results of 408 bacterial pneumonia children less than 5 years of age admitted to the general wards of Chengdu Pidu Maternal and Child Health Hospital and Chengdu Women's and Children's Central Hospital from November 2021 to June 2023.A descriptive analysis was performed on the detection of common pathogenic bacteria in different age groups and children of different genders as well as drug resistance of pathogenic bacteria.ResultsAmong the 408 children with pneumonia,368(90.20%)were infected with one kind of pathogenic bacteria,and 40(9.80%)with two or more kinds of pathogenic bacteria.468 strains of pathogenic bacteria were detected in the sputum samples,including 165(35.26%)strains of Gram-positive bacteria and 303(64.74%)strains of Gram-negative bacteria.The main pathogenic bacteria detected were Streptococcus pneumoniae(31.41%),Haemophilus influenzae(24.79%),Moraxella catarrhalis(19.02%),Viridans streptococci(15.81%)and Staphylococcus aureus(3.85%).No statistically significant differences were found in the detection rates of 5 major pathogenic bacteria between children of different genders(P>0.05).The detection rate of Streptococcus pneumoniae was higher in 1-3-year-old group and>3-5-year-old group than in<1-year-old group,while the detection rates of Haemophilus influenzae and Staphylococcus aureus were lower in 1-3-year-old group and>3-5-year-old group than in<1-year-old group(P<0.05).The detection rate of Streptococcus pneumoniae was higher in winter than in autumn,and the detection rate of Haemophilus influenzae was higher in spring than in summer,autumn and winter(P<0.05).The drug resistance rates of Streptococcus pneumoniae and Moraxella catarrhalis to co-trimoxazole were the highest,which were 53.74%and 22.47%respectively.The drug resistance rates of Haemophilus influenzae and Staphylococcus aureus to ampicillin were the highest,which were 67.24%and 83.33%respectively.The drug resistance rates of Viridans streptococcus to ampicillin and ceftriaxone were the highest,which were both 51.35%C.onclusionnStreptococcus pneumoniae,Haemophilus influenzae,Moraxella catarrhalis,Viridans streptococcus and Staphylococcus aureus are main pathogenic bacteria of pneumonia in the children in this area.The distribution of pathogenic bacteria in the children of different ages and different seasons is diversity.Sensitive antibacterial drugs should be rationally selected and used based on drug resistance characteristics of pathogenic bacteria in clinical practice.