小儿下呼吸道感染病原菌分布与耐药性分析

目的 调查下呼吸道感染患儿的主要病原菌及其对常用抗菌药物的耐药性,为临床合理选择抗菌药物提供依据.方法 对3335例小儿下呼吸道感染患儿痰标本进行培养,采用美国MicroScan WalkAway 40型微生物分析仪,对细菌进行鉴定并做药敏试验,应用WHONET 5.4软件对数据进行分析.结果 3335份标本中检出病原菌1659株,分离率为49.7％,其中革兰阴性杆菌1423株占85.8％,以肺炎克雷伯菌、大肠埃希菌为主,肺炎克雷伯菌、大肠埃希菌中产ESBLs检出率分别为31.1％、43.0％,对亚胺培南的耐药率低；革兰阳性球菌218株占13.1％,以金黄色葡萄球菌为主,对万古霉素、利奈唑胺最敏感；真菌18株占1.1％.结论 小儿下呼吸道感染病原菌以革兰阴性菌为主,不同菌种对抗菌药物耐药性存在很大差异,临床在抗菌药物使用中应加强病原菌的检测,根据药敏结果科学选择,提高治疗效果,延缓细菌对抗菌药物耐药性的产生.

Distribution and drug resistance of pathogens causing lower respiratory tract infections in children

OBJECTIVE To investigate the major pathogens isolated from children with lower respiratory tract infections and their drug resistance to commonly used antibiotics so as to provide basis for clinical reasonable use of antibiotics.METHODS Sputum samples obtained from 3335 children patients were cultured.MicroScan WalkAway 40 was used to assess the bacteria and test the drug sensitivity.The data were analyzed with software WHONET 5.4.RESULTS Totally 1659 isolates were detected in totally 3335 sputum specimens,including 1423 strains of gram-negative bacilli(85.8%),218 strains of gram-positive cocci(13.1%),and 18 strains of fungi(1.1%),with the isolation rate of 49.7%.Klebsiella pneumoniae and Escherichia coli were the main gram-negative strains in which the detection rates of extended-spectrum β-lactamases(ESBLs) were 31.1% and 43.0%,respectively,the resistance rate of these isolates to imipenem was low;S.aureus was the main gram-positive cooci and most susceptible to vancomycin and linezolid.CONCLUSION The gram-negative bacteria are the main pathogens and different bacterial species varied significantly in the antibiotics resistance.The clinic should strengthen the detection of the pathogens and select antibiotics on the basis of drug susceptibility testing so as to improve the therapeutic effect and delay the bacterial resistance.