泉州地区儿童社区获得性肺炎的病原学特点及耐药情况分析

Drug resistance situation and etiology characteristics analysis of children with community-acquired pneumonia in Quanzhou area

目的:探讨泉州地区儿童社区获得性肺炎的病原学特点及细菌耐药情况,为临床治疗提供依据。方法:2011年1月-2013年1月收治获得性肺炎患儿1 746例,对临床资料包括病原学构成及细菌耐药情况、临床表现、纤维支气管镜、影像特点、辅助检查等进行统计学分析。结果:11 746例患儿中病原学检查阳性655例(37.5%),主要以婴幼儿为主。2细菌感染253例(38.6%),病毒感染169例(25.8%),肺炎支原体/衣原体/嗜肺军团菌感染97例(14.8%);混合感染65例(9.9%);细菌感染最多的为肺炎链球菌、金黄色葡萄球菌、流感嗜血杆菌、卡他莫拉菌;病毒感染最多见为RSV、流感、副流感;非典型菌最多为肺炎支原体、沙眼衣原体;MP多见于>3岁患儿与<3岁患儿对比差异有统计学意义(χ2=58.03,P<0.01);两种病原体混合感染多见年龄<6个月的患儿与>1岁患儿比较差异有统计学意义(χ2=87.1,P<0.01)。3检出肺炎链球菌87株中,青霉素耐药肺炎链球菌(PRSP)45株,对红霉素、克林霉素全部耐药,对万古霉素均敏感。检出产超广谱-内酰胺酶(ESBLs)菌株22株,其中大肠埃希氏13株,肺炎克雷伯杆菌9株,对氨苄西林、头孢类抗生素全部耐药,其中1株对美洛培南耐药,对亚胺培南全部敏感。4降钙素原及CRP的检测有助于鉴别细菌或病毒感染引起的CAP。结论:泉州地区儿童社区获得性肺炎多见于婴幼儿为主,细菌以肺炎链球菌及金黄色葡萄球菌为主,病毒感染为RSV、流感、副流感为主,RSV及混合感染多见于<6个月婴幼儿。降钙素原及CRP的检测有助于鉴别细菌或病毒感染引起的CAP;了解本地区CAP病原体特点及降钙素原及C-反应蛋白检测有助于避免滥用抗生素。

Objective:To explore the etiology characteristics and bacterial drug resistance of children community acquired pneumonia in Quanzhou area,to provide the basis for clinical treatment.Methods:1 746 children with acquired pneumonia were selected from January 2011 to January 2013.The clinical data including etiology constitutes,bacterial drug resistance,clinical manifestation,fiberoptic bronchoscopy,imaging characteristics and auxiliary examination were statistically analyzed.Results:1655cases(37.5%) were etiology examination positive in 1746 children,mainly infants and young children.2253 cases(38.6%) were bacterial infection;169 cases(25.8%) were viral infection;97 cases(14.8%) were pneumonia mycoplasma/chlamydia/legionella pneumophila infection;65 cases(9.9%) were mixed infection.The bacterial infection was the most common streptococcus pneumoniae,staphylococcus aureus,haemophilus influenzae,moraxella catarrhalis.The virus infection was the most common RSV,influenza,parainfluenza.The atypia bacteria was the most common mycoplasma pneumoniae, chlamydia trachomatis.More than 3years old children with MP and less than 3 years old children with MP were compared with significant difference(χ2=58.03,P<0.01).Less than 6 months children with two kinds of pathogens mixed infection and more than 1 years old children were compared with significant difference(χ2=87.1,P<0.01).3In the detection of 87 strains of streptococcus pneumoniae,45 strains were penicillin resistant streptococcus pneumoniae(PRSP);they were all resistance for erythromycin and clindamycin;they were all sensitive to vancomycin.In the detection of 22 strains of extended spectrum-lactamases(ESBLs).Including 13 strains of escherichia coli,9 strains of klebsiella pneumoniae,they were all resistance for ampicillin and cephalosporins antibiotics;they were all sensitive to vancomycin,including 1 strain was resistance for meropenem;they were all sensitive to imipenem.4The detection of procalcitonin and CRP is helpful in differentiating CAP caused by bacteria or virus infection.Conclusion:Children community acquired pneumonia in Quanzhou area is mainly found in infants and young children.Bacteria is mainly streptococcus pneumoniae and staphylococcus aureus,and the virus infection is mainly RSV,influenza,parainfluenza.RSV and mixed infection are more common in less than 6 months infants.The detection of procalcitonin and CRP is helpful in differentiating CAP caused by bacteria or virus infection.To understand local area CAP pathogen characteristics and the detection of procalcitonin and CRP help to avoid the abuse of antibiotics.