小儿呼吸道感染细菌病原菌分布及耐药性研究

Study on Distribution and Drug Resistance of Bacterial Pathogens in Children with Respiratory Tract Infections

目的:研究小儿呼吸道感染常见细菌病原菌的分布及对常见抗菌药物耐药的情况,指导临床合理选择使用抗菌药物。方法:选取2017年在我院儿科住院治疗的415位呼吸道感染患者,采集患儿痰标本进行细菌病原菌类型的培养和常用抗菌药物敏感性试验。结果:共检测出病原菌142株,阳性率为34.22%;其中革兰阳性菌74株,占52.11%;革兰阴性菌65株,占45.77%;真菌3株,占2.11%;病原菌前5位依次是金黄色葡萄球菌、大肠埃希菌、肺炎链球菌、肺炎克雷伯菌和流感嗜血杆菌;检测出耐甲氧西林金黄色葡萄球菌(MRSA)占30.7%,耐青霉素肺炎链球菌(PRSP)占37.6%,两者对万古霉素的敏感性均高;检测出大肠埃希菌和肺炎克雷伯杆菌分别占42.3%和18.1%,对头孢替坦、哌拉西林/他挫巴坦、厄他培南、亚胺培南四种抗菌药物的敏感性均较高;检测出流感嗜血杆菌占44.3%,对氨苄西林的耐药性有50.0%。结论:我院小儿呼吸道感染的细菌病原菌以革兰阳性菌为主,临床上要对细菌病原菌类型的培养和常用抗菌药物敏感性多加检测,并根据常用抗菌药物敏感性结果来合理选择抗菌药物进行相关治疗。

Objective:To study the distribution of common bacterial pathogens in children with respiratory tract infections and their resistance to common antimicrobials so as to guide the rational selection and use of antimicrobials.Methods:415 patients with respiratory tract infections who were hospitalized in the pediatrics department of our hospital in 2017 were selected to collect sputum samples for the culture of bacterial pathogens and the sensitivity test of common antimicrobials.Results:A total of 142 strains of pathogens were detected,with a positive rate of 34.22%.Among them,there were 74 strains of Gram-positive bacteria,accounting for 52.11%,65 strains of Gram-negative bacteria,accounting for 45.77%and 3 strains of fungi,accounting for 2.11%.The top five strains of pathogens were Staphylococcus aureus,Escherichia coli,Streptococcus pneumoniae,Klebsiella pneumoniae and Haemophilus influenzae.methicillin-resistant Staphylococcus aureus(MRSA)accounted for 30.7%,penicillin-resistant Streptococcus pneumoniae(PRSP)accounted for 37.6%,and both of which were highly sensitive to vancomycin.Escherichia coli and Klebsiella pneumoniae accounted for 42.3%and 18.1%,respectively,and both of which were highly sensitive to cefotetan,piperacillin/tazobactam,ertapenem and imipenem antimicrobials.Haemophilus influenzae accounted for 44.3%,and its resistance to ampicillin was 50.0%.Conclusion:Gram-positive bacteria are the main bacterial pathogens in the children with respiratory tract infections in our hospital.Clinically,the culture of bacterial pathogens and the sensitivity of common antimicrobials should be more tested.Antimicrobials are chosen reasonably according to the results of the sensitivity of common antimicrobials in common use for relevant treatment.