儿童社区获得性肺炎病原菌分布及其耐药性变迁分析

目的 了解儿童社区获得性肺炎病原菌分布并分析其耐药变迁情况,以指导儿科临床更合理地使用抗菌药物.方法 将7所医院儿科4806例社区获得性肺炎患儿痰标本进行培养,采用API及全自动细菌鉴定系统分离菌株,根据美国临床实验室国家标准化委员会(NCCLS)制定的标准进行药敏试验,并检测超广谱β-内酰胺酶、AmpC酶及耐甲氧西林的葡萄球菌,将试验阳性资料进行统计分析.结果 共分离1127株病原菌,革兰阴性(G-)菌628株(55.7％),其中肺炎克雷伯氏菌多见,大肠埃希氏菌次之；革兰阳性(G+)菌466株(41.4％),以肺炎链球菌为主,金黄色葡萄球菌次之；念珠菌33株(2.9％).G-菌对氨苄西林、第]代头孢类药物耐药率最高(91.4％～94.3％),对亚胺培南敏感.肺炎克雷伯菌、大肠埃希菌产超广谱β-内酰胺酶( ESBLs)与头孢菌素酶(AmpC酶)分别为58.8％、55.0％与19.8％、12.3％；G+菌对青霉素、苯唑西林、红霉素耐药率最高(93.3％～100.0％),对万古霉素敏感.结论 儿童社区获得性肺炎病原菌以革兰阴性菌、革兰阳性菌为主.因儿科多选用β-内酰胺类、大环内酯类两大类抗生素,致使病原菌产生ESBLs较高,产AmpC酶菌也占一定比例.细菌耐药情况严重,重视痰培养及药敏检测意义重大.

Changes of pathogens and drug resistance in community-acquired pneumonia in children

Objective To analyze the changes of pathogens and drug resistance in communityacquired pneumonia （ CAP ） in children to provide guidence for optimal uses of antibiotics. Methods Sputum samples from 4806 children with CAP at seven hospitals were cultured. Bacterial strains were isolated and identified by API or the MicroScan WalkAway 40 SI. Antimicrobial susceptibility was tested; and ESBLs, AmpC, and MRS were examined according to the criteria of NCCLS guidelines. The WHONET 5.0 software was used for analysis of antimicrobial resistance. Results Among 1127 isolated pathogenic strains, 628 （ 55.7% ）were gram-negative, mostly Klebsiella pneumoniae, followed by Escheriehia coli 466 （ 41.4% ）were gram-positive cocci, mostly Streptococcus penumoniae, followed by Staphylococcus aureus; 33 （ 2.9% ）were Candida.Gram-negative bacilli had the highest resistant rate （ 91.4% - 94.3% ） to ampicillin and the first generation of cephalosporins, but is susceptible to imipenem. The rates of producing ESBLs and AmpC were 58.8% and 19.8% for Klehsiella pneumonia and 55.0% and 12.3% for Escheriehia toll, respectively. Gram-positive cocci had the highest resistant rate （ 93.3% - 100.0% ） to penicillin, oxacillin sodium, and erythromycin. Conclusions The main pathogens for CAP in children were gramnegative strains and gram-positive cocci. Due to the frequent uses of β-laetams and macrolides in the department of pediatrics, pathogens produce ESBLs and AmpC highly. The pathogens have severe drug resistance to antibiotics. It is of importance for sputum cultures and testing antimicrobial resistance.