儿童社区获得性肺炎革兰氏阴性多重耐药菌的分布与耐药率分析

Distribution and drug resistance rate of multidrug-resistant Gram-negative bacteria in children with community-acquired pneumonia in Haikou

目的了解海口市儿童社区获得性肺炎住院患者感染革兰氏阴性多重耐药菌的分布与耐药率,为降低患者感染率及耐药率提供依据。方法选取2012年1月至2014年12月我院儿科6岁以下社区获得性肺炎住院患者入院后送检的9 569份痰液标本进行细菌学分离及培养,对革兰氏阴性多重耐药菌的分布及耐药率进行分析。结果送检的9 569份标本中分离出病原菌3 740株,占39.08%;3 740株病原菌中分离出多重耐药菌408株,占10.9%,主要是ESBLS(+)大肠埃希菌(ESBLs-ECO)、ESBLS(+)肺炎克雷伯菌(ESBLs-KPN)、多药耐药铜绿假单胞菌(MDR-PA)、多药耐药鲍曼不动杆菌(MDR-AB),其中ESBLs(+)肺炎克雷伯及大肠埃希菌为主要多重耐药病原菌。ESBLs(+)肺炎克雷伯及大肠埃希菌阳性率有逐年上升趋势。各年龄段革兰氏阴性多重耐药菌以ESBLs(+)肺炎克雷伯及大肠埃希菌所占比例最高,且主要分布在婴儿组,分别为19.6%及14.8%。革兰氏阴性多重耐药菌对氨苄西林、阿莫西林克拉维酸钾及头孢菌属类抗生素耐药率在80%以上,对妥布霉素耐药率为5%~40%,对复方新诺明耐药率为10%~53%,对左氧氟沙星耐药率为5%~10%,对哌拉西林他唑巴坦耐药率在12%以下,对阿米卡星及亚胺培南耐药率低在6%以下。结论 ESBLs(+)肺炎克雷伯及大肠埃希菌是海口地区6岁以下儿童社区获得性肺炎革兰氏阴性多重耐药菌主要致病菌,婴幼儿为感染高危人群,应加强监测。多重耐药菌对常用抗生素耐药率高,规范使用抗生素是控制耐药率的重要途径。

Objective To analyze the distribution and drug resistance rate of multidrug-resistant(MDR)Gram-negative bacteria(GNB) in children with community-acquired pneumonia in Haikou, and provide evidence for reducing the infection rate and the drug resistance rate. Methods A total of 9 569 sputum specimens were collected from the children under 6 years old who admitted to the department of pediatrics of our hospital for the treatment of community-acquired pneumonia from January 2012 to December 2014. The sputum samples were isolated and cultured for analyzing the distribution and drug resistance rate of multidrug-resistant Gram-negative bacteria. Results A total of 3 740 strains of pathogenic bacteria were isolated from 9 569 sputum specimens(39.08%). In 3 740 strains, multidrug-resistant bacteria accounted for 10.9%(408 strains). The main multidrug-resistant bacteria included extended spectrum β-lactamase(ESBL)-producing Escherichia coli(ESBLs-ECO), ESBL-producing Klebsiella pneumoniae(ESBLs-KPN), multidrug-resistant Pseudomonas aeruginosa(MDR-PA) and multidrug-resistant Acinetobacter baumannii(MDR-AB), among of these ESBLs-ECO and ESBLs-KPN were most important multidrug-resistant pathogenic bacteria. Positive rate of ESBLs-KPN and ESBLs-ECO had a rising trend year by year. ESBLs-KPN and ESBLs-ECO had the highest incidence in all age groups, especially in infants with positive rate of 19.6% and 14.8% respectively. The resistance rates of MDR GNB to ampicillin, amoxicillin-clavulanic acid potassium and Cephalosporium were more than 80%, and the resistance rates of MDR GNB to tobramycin, compound sulfamethoxazole, levofloxacin, piperacillin pull, amikacin and imipenem were respectively 5%~40%, 10%~53%, 5%~10% <12%, and<6%. Conclusion ESBLs-KPN and ESBLs-ECO were the principal pathogenic bacteria of community-acquired pneumonia in children under 6 years old in Haikou, and infants have the higher risk of infection, so measures should be taken to strengthen monitoring. The MDR GNB have the higher resistance rate to common antibiotics, so the reasonable use of antibiotics is an important way to control the resistance rate.