重庆地区748例儿童重症社区获得性肺炎病原学特点及耐药性分析

目的分析重庆地区748例儿童重症社区获得性肺炎(CAP)的病原学特点及耐药性。方法回顾性分析重庆市中医院2017年1月至2019年12月收治的748例重症CAP患儿的临床资料,分析患儿感染致病菌的病原学特征。结果细菌检出率从高到低为流感嗜血杆菌(29.1%)、金黄色葡萄球菌(15.9%)、肺炎链球菌(14.8%)。在<1岁和1~<3岁年龄段,流感嗜血杆菌占比最高,分别为32.0%及47.5%;在3~<6岁年龄段,以肺炎链球菌多见,占34.4%;在≥6岁年龄段,则以卡他莫拉菌为主,占50.0%。流感嗜血杆菌在冬季检出最多为54株(36.0%);金黄色葡萄球菌在秋季检出最多为26株(31.7%);肺炎克雷伯菌肺炎亚种在夏季检出最多为8株(40.0%)。不同季节之间细菌检出率比较,差异有统计学意义(χ^2=33.794,P<0.05)。革兰阴性菌中,流感嗜血杆菌、卡他莫拉菌、大肠埃希对第三代头孢菌素耐药率小于60%;革兰阳性菌中,金黄色葡萄球菌、肺炎链球菌对阿莫西林/棒酸、阿莫西林耐药率为24.4%、13.2%,未发现万古霉素的耐药菌株。结论重庆地区重症CAP患儿主要见于婴幼儿,不同年龄、季节,细菌的分布有所不同,临床经验性用药时应结合发病季节及患儿年龄进行选择。

Analysis of the bacterial pathogens and bacterial resistance in 748 children with severe community acquired pneumonia of Chongqing

Objective To investigate the etiological characteristics and bacterial resistance situation in 748 children with severe community acquired pneumonia(CAP)in Chongqing.Methods The clinical data from the 748 children with severe CAP between January 2017 and December 2019 from Chongqing Traditional Chinese Medicine Hospital were retrospective analyzed,as well as pathogenic characteristics of pathogenic bacteria in children with infection.Results Among the bacteria which were detected,Haemophilus influenzae(29.1%),Staphylococcus aureus(15.9%),Streptococcus pneumoniae(14.8%)turned out to be the predominant bacteria.Haemophilus influenzae accounted for the highest proportion in children aged lower than 1 year old(32.0%)and 1 to 3 years old(47.5%).Streptococcus pneumoniae was more common in the age group of 3 to 6 years old(34.4%).And Moraxella catarrhalis was predominant in the age group higher than 6 years old(50.0%).In winter,54 strains(36.0%)of Haemophilus influenzae were detected,26 strains(31.7%)of Staphylococcus aureus were detected in autumn,8 strains(40.0%)of Klebsiella pneumoniae subspecies pneumoniae were detected in summer.The bacterial detection rates between different seasons were statistically significant(χ^2=33.794,P<0.05).Among the Gram negative bacteria,Haemophilus influenzae,Moraxella catarrhalis and Escherichia coli had less than 60%resistance rates to third generation cephalosporins.Among the Gram negative bacteria,the resistance rates of Staphylococcus aureus and Streptococcus pneumoniae were 24.4%and 13.2%to amoxicillin/clavulanic acid and amoxicillin.No vancomycin resistant bacteria were found.Conclusion Children with severe CAP in Chongqing are mainly seen in infants and young children.The distribution of bacteria varies with age and season.Clinical empirical drug use should be combined with the onset season and age of children.