2001~2006年成都市儿童医院常见下呼吸道病原菌分布及耐药性检测

目的：了解成都地区小儿下呼吸道感染疾病常见致病菌的分布情况及抗生素耐药的变化趋势。方法：对成都市儿童医院2001~2006年下呼吸道感染住院患儿痰液培养所分离的所有菌株进行分析，试验方法严格按照美国国家临床试验室标准委员会（NCCLS）最新标准进行。结果：该研究中2001~2003年下呼吸道病原菌依次为：嗜血杆菌属24.3%，肺炎链球菌18.8%，大肠埃希菌18.2%，肺炎克雷伯菌11.3%、金黄色葡萄球菌10.0%，表皮葡萄球菌6.5%，铜绿假单胞菌6.4%，其他非发酵菌4.4%；2004~2006年主要病原菌以革兰阴性菌为主（64%），依次为：大肠埃希菌23.7%，嗜血杆菌属19.8%，肺炎链球菌17.9%，肺炎克雷伯菌13.2%，金黄色葡萄球菌10.3%，表皮葡萄球菌7.8%，铜绿假单胞菌4.0%，其他非发酵菌3.2%。2004~2006年与2001~2003年比较，病原菌总体耐药情况呈上升趋势。2001~2003年耐甲氧西林金黄色葡萄球菌（MRSA）检出率为8.8%，耐甲氧西林凝固酶阴性的葡萄球菌（MRCNS）菌株检出率为18.1%，大肠埃希菌和肺炎克雷伯菌ESBLs阳性菌株合计检出率为22.6%，流感嗜血杆菌产β-内酰胺酶率20.1%；2004~2006年MRSA菌株为18.0%、MRCNS菌株为70.5%，大肠埃希菌和肺炎克雷伯菌ESBLS+菌株合计检出率为44.4%，流感嗜血杆菌产β-内酰胺酶率40.2%。结论：近3年来该院儿科常见下呼吸道病原菌分布排序已发生变化，病原菌总体耐药情况呈上升趋势，病原菌常见耐药表型检出率明显增加应引起临床医师和医院感染管理部门高度关注。［中国当代儿科杂志，2008，10（1）：17-20］

Distribution and drug resistance of pathogenic bacteria in children with lower respiratory tract infection from Chengdu Children's Hospital between 2001 and 2006

OBJECTIVE: To investigate the distribution and the changes of drug resistance of common pathogenic bacteria in children with lower respiratory tract infection (LRTI) of Chengdu. METHODS: Sputum specimens for bacterial cultures were collected from children with LRTL who had been admitted to the Chengdu Children's Hospital between 2001 and 2006. Antibiotic susceptibility tests were performed after bacteria had been identified. The results between 2001 and 2003 were compared with those between 2004 and 2006. RESULTS: Hemophilus (24.3%) was the most common pathogenic bacteria for LRTI in children between 2001 and 2003, followed by Streptococcus pneumoniae (18.8%), Escherichia coli (18.2%), Klebsiella pneumoniae (11.3%), Staphylococcus aureus (10.0%), Staphylococcus epidermidis (6.5%), Pseudomonas aeruginosa (6.4%) and other non-zymocyte (4.4%). Escherichia coli (23.7%) was the most common pathogenic bacteria in children with LRTL between 2004 and 2006, followed by Hemophilus (19.8%), Streptococcus pneumoniae (17.9%), Klebsiella pneumoniae (13.2%), Staphylococcus aureus (10.3%), Staphylococcus epidermidis (7.8%), Pseudomonas aeruginosa (4.0%) and other non-zymocyte (3.2%). Compared with the years of 2001-2003, the rate of drug resistance of pathogenic bacteria to antibiotics between 2004 and 2006 increased: Methicillin-resistant Staphylococcus aureus 18.0% vs 8.8%, Methicillin-resistant coagulase-negative Staphylococci 70.5% vs 18.1%, Extended-spetrum β-lactamase stains 44.4% vs 22.6%, and β-lactamase production stains of Hemophilus influenzae 40.2% vs 20.1%. CONCLUSIONS: The distribution of common pathogenic bacteria of children with LRTL has changed and the rate of drug resistance of pathogenic bacteria to antibiotics is increasing in recent three years in Chengdu.