小儿急性下呼吸道感染病原菌检测及药敏分析

目的调查本院收治的小儿下呼吸道感染中的常见细菌在各年龄组的分布及药物敏感性,以指导临床用药。方法对本院2008~2009年儿科收治的856例急性下呼吸道感染痰培养阳性者应用K-B法进行药敏试验。结果明确有细菌感染的为415份,阳性率48.5%,共获病原菌439株,其中革兰氏阴性菌308株。所获取的病原依次为大肠埃希氏菌98株,肺炎克雷伯菌84株,金黄色葡萄球菌72株,副流感嗜血杆菌63株,铜绿假单胞菌35株,肺炎链球菌22株,流感嗜血杆菌17株,其他48株;肺炎链球菌、流感嗜血杆菌随年龄增长而感染率逐渐升高,肺炎链球菌感染率在〉1岁患儿与〈1岁患儿之间差异有非常显著性（χ2=35.10,P〈0.001）。大肠埃希氏菌感染率在〈1岁与〉1岁患儿之间差异有非常显著性（χ2=11.02,P〈0.005）。大肠埃希氏菌和肺炎克雷伯菌对亚胺培南、哌拉西林/舒巴坦、头孢吡肟、头孢曲松、头孢他啶的敏感率高;金黄色葡萄球菌对万古霉素、头孢唑啉敏感率高;而肺炎链球菌对万古霉素、头孢唑啉、苯唑西林、青霉素、克林霉素的敏感率高。结论衡阳地区小儿下呼吸道感染的主要病原菌为革兰阴性杆菌,其中尤以大肠埃希菌、肺炎克雷伯菌多见,不同菌种对抗生素药物敏感性和耐药性均存在差异。应根据药敏试验合理选用抗生素治疗。

Etiology and Drug-sensitivity Study on Acute Lower Respiratory Tract Infection

Objective To investigate the distributed condition of common bacteriums in every age group and drug sensitivity in pediatric patients with acute lower respairatory tract infection,eight hundred and fifty six sputum specimens treated by our hospital were tested.Methods The drug sensitivity testing was performed by the method of K-B.Results Four hundred and fifteen patients（48.5%）were bacteria-positive.A total of 439 strains were obtained,308 strains were gram-negative.The Pathogens obtained were 98 strains of Escherichia coli（E.coli）,84 strains of Klebsiella pneumoniae（K.pneumoniae）,72 strains of Staphylococcus aureus（S.aureus）,63 strains of Haemophilus parainfluenzae,35 strains of Pseudomonas aeruginosa,22 strains of Streptococcus pneumoniae（S.pneumoniae）,17 strains of Haemophilus influenzae,and the other 48 strains.The sensitive ratio of S.pneumoniae and Haemophilus influenzae was increased with the age,and the sensitive ratio of S.pneumoniae was obviously different between the patients above one and the patients under one,χ2 =35.10,P0.001.The sensitive ratio of E.coli was obviously different between the patients under one and the patients above one,χ2 =11.02,P0.005.The sensitive ratio of E.coli and K.pneumoniae to Imipenem-Cilastatin,Piperacillin-Sulbactam,Cefepime,Ceftriaxone,Ceftazidime was high,and the sensitive ratio of S.aureus to Vancomycin,Cefazolin was high,and the sensitive ratio of S.pneumoniae to Vancomycin,Cefazolin,Oxacillin,Penicillin,Clindamycin was high.Cnclusions Gram-negative bacteria were the main pathogens in children from Hengyang with lower respiratory tract infection,and E.coli and K.pneumoniae were common.The antibiotic susceptibility of pathogenic bacteria varied with different strains of bacteria.A reasonable selection of antibiotics should be based on the antibiotic susceptibility test.