5岁以下儿童门诊呼吸道感染常见病原携带及抗生素耐药的流行病学特征调查

Epidemiologic survey of pathogen carriage and antimicrobial resistance among children aged under 5 years with acute respiratory tract infections

目的 了解 5岁以下儿童呼吸道感染肺炎链球菌 (SP)、流感嗜血杆菌 (HI)、卡他莫拉菌 (M .Cat)携带株的流行病学特征、耐药情况及其影响因素。方法 对 2 0 0 0年 1月至 2 0 0 3年 5月在北京儿童医院内科门诊就诊的≤ 5岁呼吸道感染儿童进行随机选择问卷调查 ;采鼻咽拭子标本 ;培养、分离、鉴定SP、HI,其中对 2 0 0 2年 1月至 2 0 0 3年 5月的标本同时进行了M .Cat的分离 ;用E test、K B法检测SP、HI对抗生素的敏感性 ,用琼脂扩散法检测M .Cat的药物敏感性 ;评价年龄、居住地、入托、抗生素使用、诊断对病原携带及其耐药株的影响。结果 本文≤ 5岁儿童呼吸道感染SP、HI、M .Cat的携带率分别为 2 8 6%、2 8 3%、1 5 8%。SP青霉素耐药率为 2 3 3% ,HI氨苄青霉素的耐药率为 1 0 2 % ,M .Cat对氨苄青霉素的耐药率高达 90 3%。影响病原携带、抗生素耐药的主要因素有年龄、入托、抗生素使用。结论 ≤ 5岁儿童呼吸道感染携带病原菌株耐药率快速上升 ,抗生素使耐药菌株携带率增高 ,因而合理使用抗生素非常重要。

Objective To investigate the nasopharyngeal carriage rates of streptococcus pneumoniae(SP),Haemophilus influenzae (HI) and Moraxella catarrhalis (M.Cat) among children under 5 years with acute respiratory tract infections,and to determine the risk factors for carriage of pathogens and antimicrobial resistant strains.Methods Totally 1655 patients aged between 1 month and 5 years with acute respiratory tract infections admitted from January 2000 to May 2003 were randomly selected.A questionnaire including sex,age,address,day care attendance,diagnosis and recent antimicrobial use was used.Nasopharyngeal swabs were collected and cultured for SP,HI and M.Cat respectively,and the antimicrobial susceptibility was determined by E-test,K-B and agar diffusion methods.Results Nasopharyngeal carriages of SP,HI and M.Cat were 28.6%,28.3% and 15.8%,respectively.Resistant penicillin SP strains were 23.3%;resistant ampicillin HI strains were 10.2%;resistant ampicillin M.Cat strains were 90.3%.Risk factors affecting nasopharyngeal carriage of bacterial agents and antimicrobial resistance were age,day care attendance and antimicrobial use.Conclusion The resistant strains of pathogens have increased rapidly in Beijing.The rational use of antimicrobial is very important.