呼吸重症监护病房免疫功能低下患者肺炎病原学特点分析

目的 了解呼吸重症监护病房免疫功能低下患者(ICH)肺炎病原体特点及耐药情况,为临床经验性选择抗菌药物提供依据.方法 对2005年1月至2008年4月收住北京朝阳医院呼吸重症监护病房的52例ICH肺炎的痰或肺泡灌洗液培养及药敏试验结果进行回顾性分析.结果 52例ICH肺炎中20例医院获得性肺炎检出42株菌,其中革兰阴性杆菌15株(36.0%),以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为主;革兰阳性球菌13株(31.0%),以肠球菌属和金黄色葡萄球菌为主;真菌11株(26.2%),以曲霉菌和白色念珠菌为主;肺孢子菌3株(7.1%).32例社区获得性肺炎检出57株菌,其中革兰阴性杆菌19株(33.3%),以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为主;革兰阳性球菌16株(28.1%).以肠球菌和金黄色葡萄球菌为主;真菌16株(28.1%),以曲霉菌和白色念珠菌为主;肺孢子菌6株(10.5%).药敏试验显示铜绿假单胞菌对抗生素多重耐药率较高,鲍曼不动杆菌和肺炎克雷伯菌仍对碳青霉烯类较敏感.肠球菌属对万古霉素的耐药率为20.0%,未发现耐万古霉素的葡萄球菌.结论 ICH肺炎中的医院获得性肺炎和社区获得性肺炎病原学特点无差异,感染真菌和革兰阳性球菌比例较高,肺孢子菌肺炎应引起重视,多重耐药菌株高发,耐药率一致.     

难治性下呼吸道感染患者BALF病原菌分布及药敏分析

目的：探讨新疆自治区人民医院难治性下呼吸道感染患者支气管镜肺泡灌洗液( BALF)病原菌分布及其药敏状况,为临床合理用药提供依据。方法收集2013年6月到2015年5月难治性下呼吸道感染中BALF标本,对分离培养结果及药敏实验结果进行回顾性分析;结果难治性下呼吸道感染肺泡灌洗阳性患者255例,共培养出287株病原菌,革兰阳性菌占26．5%,革兰阴性菌占70．7%,真菌占2．8%,革兰阴性菌中排列于前4位的主要菌种依次是肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌,其中鲍曼不动杆菌普遍耐药程度最高,对亚胺培南和美罗培南耐药率较高,分别为68%、64%,对米诺环素及阿米卡星最为敏感;革兰阳性菌主要为金黄色葡萄球菌41株。未见万古霉素耐药菌株。结论难治性下呼吸道感染患者肺泡灌洗液主要以革兰阴性杆菌为主,各种病原菌对抗菌药物的敏感度各不相同,差异较大,加强病原菌耐药性检测有助于治疗方案的制定或调整,及早控制感染。     

Antimicrobial resistance pattern among aerobic gram-negative bacilli of lower respiratory tract specimens of intensive care unit patients in a neurocentre

BACKGROUND: Analysis of the tracheal and bronchial isolates from the lower respiratory tract specimens of the intensive care unit (ICU)-admitted patients, was carried out for the year 2002 with a perspective of looking at the antibiotic resistance pattern. METHODS: Lower respiratory tract secretions (tracheal or bronchoscopic aspirates) of 370 patients were cultured, identified and antimicrobial susceptibility performed by standard methods. RESULTS: Out of samples obtained from 370 patients, 274 (74%) were culture positive. A total of 489 bacterial isolates were recovered from 270 patients; 451 were gram-negative bacilli (GNB) and 38 were Staphylococcus aureus. In four of the patients, Candida spp was isolated. The common GNB isolates were non-fermentative gram-negative bacilli (NFGNB, 31.9%), followed by Pseudomonas aeruginosa (21.5%) and Klebsiella spp (19%). Elderly (24.8%) and adults (19.2%) showed increased rate of GNB isolation. In both tracheal and bronchial GNB isolates, the highest mean resistance was to cefazolin (98.8%) and ampicillin (97.6%) while the lowest mean resistance was to amikacin (48.5%). Isolation of two organisms per specimen (41.4%) was commonly seen. Multidrug resistance to the tested antimicrobials was more frequent in NFGNB (6.6%) and Pseudomonas aeruginosa (5%). There were no remarkable differences in the overall mean drug resistance among tracheal and bronchial GNB isolates. CONCLUSIONS: Isolation practices, antibiotic policies, effective surveillance, maintenance of epidemiological trends of infections and, rapid molecular diagnosis are the need of hour in improved and speedy management of lung infections with resistant organisms.     

Epidemiology of extended-spectrum beta-lactamase producing gram-negative bacilli at Siriraj Hospital, Thailand, 2003

A cross-sectional study was conducted from August to September, 2003 to determine the prevalence and risk factors in acquiring extended-spectrum beta-lactamase (ESBL) producing gram-negative bacilli (GNB) in patients admitted to Siriraj Hospital and the outcomes of these infections. Of 346 isolates of gram-negative bacteria in 249 patients, 102 isolates from 87 patients were colonization only, but 244 isolates from 162 patients were infections. The common GNB were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae. The overall prevalence of ESBL producers was 30.1%. K. pneumoniae had a very high prevalence of ESBL producers (56.9%). The urinary tract was the most common site for ESBL- producing GNB infections. Nosocomial infections, duration from admission to infection, peripheral line, urinary catheterization, nasogastric tube insertion and previous use of beta-lactams, cephalosporins and fluoroquinolones were associated with acquiring ESBL-producing GNB infections. ESBL-producing GNB were significantly more resistant to antimicrobial agents. More than 80% of ESBL-producing GNB were susceptible to carbapenems. Mortality in patients infected with ESBL-producing GNB (41.3%) was significantly higher than those infected with non- ESBL-producing GNB (19.8%).     

A prospective study of infections in lung cancer patients admitted to the hospital

STUDY OBJECTIVES: To determine the type of infections occurring in hospitalized patients with lung cancer. DESIGN: Prospective cohort study. SETTING: Department of internal medicine in a cancer hospital. PATIENTS: All patients with lung cancer who were hospitalized for any cause and who acquired infections at the time of admission or during the hospital stay between January 1997 and February 2001. INTERVENTIONS: None. RESULTS: Two hundred seventy-five patients with lung cancer had 435 episodes of fever and/or microbiologically or otherwise documented infection. Two hundred eighteen patients (79.3%) presented with non-small cell lung carcinoma, while 49 patients (17.8%) had small cell lung cancer. The majority of the infections occurred in the tracheobronchial tree (56%). There were 38 episodes of bacteremia or fungemia, and the primary site of infection was identified in 18 cases (47%). Microbiologically documented infections accounted for 61% of the infectious episodes, and included a total of 312 microorganisms. The most frequent pathogens were Gram-negative bacteria (64%), followed by Gram-positive bacteria (25%) and fungi (8%). The predominant Gram-negative bacteria were Haemophilus influenzae and Moraxella catarrhalis. Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci, and Enterococcus faecalis essentially represented the Gram-positive bacteria. No multiresistant bacteria were observed. Bacteria were susceptible to most of the antibiotics classically administered for their treatment. CONCLUSIONS: The predominant site of infection in patients with lung cancer is the tracheobronchial tree, with S pneumoniae, S aureus, H influenzae, Escherichia coli, Pseudomonas aeruginosa, and M catarrhalis as the principal pathogens.     

Microbial aetiology of otitis externa

Microbiological samples were collected from the ears of patients with otitis externa for a period of 1 year. Altogether, 226 evaluable samples from 104 males and 122 females were received. The age range of the patients was similar to that of the Norwegian population. A wide variety of bacteria and fungi was isolated. The commonest isolates, excluding normal flora, were Staphylococcus aureus (34.1%), Pseudomonas aeruginosa (22.1%) and Streptococcus pyogenes (8.8%); 9.3% samples contained fungi. Of all samples, 15% showed a mixture of Gram-positive and Gram-negative, potentially pathogenic, bacteria. Infection due to Gram-negative organisms alone was commoner in males, while the lack of any obvious microbial aetiology was more frequent in females. Isolation of S. aureus together with S. pyogenes was common but that of S. aureus together with S. pyogenes was common but that of S. aureus together with P. aeruginosa was unusual. In treated patients, the finding of streptococci and S. aureus was rare whereas that of P. aeruginosa or absence of growth was common. Otitis externa involving Gram-positive bacteria seems to be more prevalent in our area than in that of other reported studies.     

泌尿道感染病人尿液病原菌鉴定及药敏结果分析

245份中段尿细菌培养阳性标本中检出革兰阳性菌44株,革兰阴性菌195株,真菌6株。肠杆菌科细菌180株,非发酵菌16株,占6.53%。革兰阴性菌中以大肠埃希菌最多,为159株,其次为肺炎克雷伯杆菌(11株)和铜绿假单胞菌(9株);革兰阳性菌中以屎肠球菌为主(21株),其次为金黄色葡萄球菌(10株)和粪肠球菌(7株)。药敏试验表明,大肠埃希菌对呋喃妥因最敏感,肺炎克雷伯杆菌对庆大霉素、丁胺卡那和诺氟沙星最敏感,屎肠球菌对万古霉素和诺氟沙星最敏感。     

Characterization of macrolide resistance in Gram-positive cocci from Colombian hospitals: a countrywide surveillance.

OBJECTIVE: The characterization of macrolide resistance in Gram-positive cocci recovered from Colombian hospitals. METHODS: The resistance profiles and mechanism of macrolide resistance were investigated in isolates of Streptococcus pneumoniae (1679), Staphylococcus aureus (348), coagulase-negative staphylococci (CoNS) (175), and Enterococcus spp (123). Minimum inhibitory concentrations (MICs) for erythromycin (ERY) and clindamycin (CLI), detection of macrolide resistance genes, phenotypic characterization, and pulsed field gel electrophoresis (PFGE) of macrolide-resistant pneumococci were performed. RESULTS: Resistance to ERY and CLI was 3.3% and 2.3% for S. pneumoniae, 58% and 57% for S. aureus (94% for both compounds in methicillin-resistant Staphylococcus aureus (MRSA)), and 78.6% and 60.7% in methicillin-resistant Staphylococcus epidermidis, respectively. ERY resistance was 62% in Enterococcus faecalis and 82% in Enterococcus faecium. The MLS(B)-type accounted for 71% of S. pneumoniae and 100% of MRSA. The erm(A) gene was prevalent in MRSA, erm(B) in S. pneumoniae and enterococci, and erm(C) in CoNS isolates. Efflux pump genes (mef(A) genes) were mostly identified in S. pneumoniae (24%). The most common genotype amongst ERY-resistant pneumococci was the Spain(6B)-2 clone. CONCLUSIONS: The prevalence of macrolide resistance is low in Colombian pneumococci and high in MRSA (cMLS(B)-type).     

呼吸机相关性肺炎的病原菌及耐药性分析

目的研究重症监护病房（ICU）内呼吸机相关性肺炎（VAP）的病原菌分布及其耐药性,为临床用药提供参考。方法以我院2007年12月～2008年12月ICU内行有创机械通气患者为研究对象,从中筛选出符合VAP临床诊断标准的病例,回顾性分析VAP的病原菌分布和耐药情况。结果36例VAP患者共培养出病原菌175株,其中G^-杆菌154株,占88％,G^＋球菌15株,占8．6％,真菌6株,占3．4％。位于前5位的病原菌依次为铜绿假单胞菌、嗜麦芽窄食单胞菌、鲍曼不动杆菌、洋葱伯克霍尔德菌、金黄色葡萄球菌。产超广谱β-内酰胺酶（ESBLs）细菌分离率为33．3％。G^-杆菌对常用抗菌药已表现出较高的耐药率,金黄色葡萄球菌耐药现象严重,耐甲氧西林金黄色葡萄球菌（MRSA）占66．7％,但对万古霉素、替考拉宁敏感。结论VAP主要病原菌为G^-杆菌且存在严重的耐药现象,对机械通气患者应严密监测病原菌,合理选用抗生素,加强管理,综合防治VAP。     

Ticarcillin: a collaborative in vitro comparison with carbenicillin against over 9,000 clinical bacterial isolates

The minimal inhibitory concentrations of ticarcillin and carbenicillin were determined for 9,236 clinical bacterial isolates by the broth microdilution method at four participating laboratories. Ticarcillin showed significantly increased activity against Klebsiella pneumoniae (P less than .001), Pseudomonas aeruginosa (P less than .001) and Aeromonas hydrophilia (P less than .005) when compared to carbenicillin, but no signifcant differences were observed against other gram-negative organisms. Ticarcillin was consistently less active against the gram-positive cocci, and these differences were significant for Staphylococcus aureus (P less than .001), Streptococcus agalactiae (P less than .001), Staphylococcus epidermidis (P less than .001) and Streptococcus viridans (P less than .005). Significant regional and institutional differences in susceptibility to the two drugs were observed for several species, including common nosocomial pathogens such as S. aureus, P. aeruginosa, K. pneumoniae and Escherichia coli.     

873例肺部感染病原菌分布及耐药性分析

目的研究本地区肺部感染病原菌分布及耐药情况。方法对我院873株病原菌培养阳性患者菌群分布及药敏试验进行分析。结果 873株病原菌菌株分布G-杆菌464株(53.2%),以铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌感染多见;G+球菌355株(40.7%),以肺炎链球菌、金黄色葡萄球菌感染多见;真菌35株(4.0%),以白色念珠菌为主;肺部感染菌群分布G-杆菌感染呈上升态势;肺部感染病原菌对各种抗生素均有不同程度的耐药现象,亚胺培南对主要的G-杆菌及有较好的敏感性,万古霉素对主要G+球菌有较好的敏感性。结论临床抗生素的使用习惯与肺部感染菌群分布及耐药密切相关,根据药敏实验选择抗生素对临床耐药菌株的减少及治疗的有效性有重要的临床意义。     

2004-2005年度全国革兰阳性菌耐药监测(Mohnarin)

目的 监测2004-2005年度全国临床分离革兰阳性菌耐药状况.方法 选定全国17家医院作为成员单位,收集特定病房2004年10月1日至2005年9月30日分离的革兰阳性致病菌,用标准平皿二倍稀释法测定35种药物体外抗菌活性,计算最低抑菌浓度(MIC)50、MIC90,依据2004年美国国家临床实验标准委员会制订的标准计算细菌对抗菌药物的耐药率、中介率和敏感率.结果 共收集革兰阳性菌925株,包括葡萄球菌536株、肠球菌249株、链球菌137株和其他革兰阳性菌3株.苯唑西林耐药金黄色葡萄球菌与苯唑西林耐药表皮葡萄球菌的检出率分别为62.9%和82.9%;肺炎链球菌对青霉素的耐药率为10.5%,中介率为30.2%,不敏感率合计为40.7%;未发现对替考拉宁中介或耐药的肠球菌,5株肠球菌对万古霉素中介,分别为1株粪肠球菌、2株屎肠球菌、1株鹑鸡肠球菌和1株鸟肠球菌;术发现糖肽类不敏感葡萄球菌.结论 革兰阳性菌耐药呈明显上升趋势,青霉素不敏感肺炎链球菌、甲氧西林耐药的葡萄球菌比例高;细菌对大环内酯类耐药率高;未发现对万占霉素耐药的革兰阳性细菌.     

Aerobic and anaerobic microbiology of paronychia

Pus specimens from 28 patients with paronychia of the finger yielded bacterial growth by techniques for cultivation of aerobic and anaerobic bacteria. Anaerobic and aerobic organisms only were isolated in pure culture in five (18%) and eight patients (29%), respectively; mixed aerobic and anaerobic flora were present in 15 patients (54%). Seventy-two isolates were recovered, or 2.6 isolates per specimen. The predominant anaerobic organisms were Gram-positive anaerobic cocci, Bacteroides species, and Fusobacterium species. The predominant aerobic organisms were Staphylococcus aureus, gamma-hemolytic streptococci, Eikenella corrodens, group A beta-hemolytic streptococci, alpha-hemolytic streptococci, and Klebsiella pneumoniae. Candida albicans was recovered in four cases. This study demonstrates the mixed aerobic and anaerobic bacteriology of paronychia.     

Antimicrobial susceptibility of isolates from neonatal septicemia

A retrospective study of bacterial isolates from cases of neonatal septicemia was undertaken over a period of 5 years (July 1998 - June 2003) at the Government Medical College Hospital, Chandigarh, India. The study was carried out to determine the bacterial profile, the antimicrobial susceptibility of the isolates, and the change in trends over the study period. A total of 3,064 blood samples for blood culture were obtained, out of which 588 were positive for bacterial isolates. Most of the cases detected by blood culture occurred in the first week of life (64.4%). Gram-negative bacilli (58.5%) predominated over Gram-positive cocci (41.5%). Staphylococcus aureus was found to be the most common isolate (35.0%).The incidence of Gram-positive and Gram-negative organisms changed little over the 5 year span. However, a constant and significant rise in the incidence of Acinetobacter spp. was observed between the first to fifth year of the study period. Amikacin was found to be the most effective drug against Gram-negative bacteria. For S. aureus and Pseudomonas aeruginosa, overall resistance percentages of 5 years show that netilmicin and ciprofloxacin, respectively, were the most effective drugs.     

心外科术后切口感染病原菌分布情况调查

目的调查心外科术后切口感染病原菌分布情况,指导临床抗感染防治。方法收集心外科术后患者临床资料。采集患者切口分泌物,经全自动微生物鉴定仪对病原菌类型进行鉴定;采用PCR法检测金黄色葡萄球菌毒力基因;对数据进行统计学分析。结果心外科手术患者496例,心外科术后切口感染患者35例,感染率7.06%;其中表浅切口感染患者22例,深部切口感染患者13例,分别占62.86%和37.14%,感染率分别为4.44%和2.62%;从心外科术后切口感染患者中共分离39株病原菌,其中革兰阳性菌21株、革兰阴性菌14株、真菌4株,构成比分别为53.85%、35.90%、10.26%;从表浅切口感染患者中分离革兰阳性菌13株,革兰阴性菌9株,真菌3株,构成比分别为52.00%、36.00%、12.00%;从深部切口感染患者中分离革兰阳性菌8株,革兰阴性菌5株,真菌1株,构成比分别为57.14%、35.71%、7.14%;分离自深部切口感染患者的金黄色葡萄球菌sasX、psm-mec、pvl毒力基因检出率分别为75.00%、25%、50%;分离自表浅切口感染患者的金黄色葡萄球菌sasX、psm-mec、pvl毒力基因检出率分别为62.50%、50.00%、37.50%。金黄色葡萄球菌毒力基因分布在表浅切口、深部切口感染中差异无统计学意义(P>0.05)。手术时间延长、术中失血、术中输血患者感染率分别为10.19%、11.17%和13.70%,感染率均高于其他患者,差异有统计学意义(P<0.05)。结论金黄色葡萄球菌是心外科术后切口感染的主要病原菌类型;金黄色葡萄球菌毒力基因与其临床致病性密切相关;手术时间延长、术中失血、术中输血是影响心外科患者术后切口感染发生的危险因素。     

老年下呼吸道感染患者的病原菌分布与耐药性分析

目的分析60岁以上老年下呼吸道感染者分离病原菌的分布规律及其耐药性特点,以指导临床合理用药。方法采用API系统进行菌种鉴定,采用K-B法进行药敏实验,采用纸片扩散表型确证法进行超广谱β-内酰胺酶(ES-BLs)测定。结果 826株病原菌中G-杆菌最多,为506株(61.26%),主要是鲍曼不动杆菌(115株),肺炎克雷伯菌(104株)和铜绿假单胞菌(99株);真菌237株,占28.69%,主要是白色假丝酵母菌(153株);G+球菌83株(10.05%),主要是金黄葡萄球菌(51株)。G-杆菌对碳青霉烯类(美罗培南)及氟喹诺酮类(环丙沙星/左氧氟沙星)抗生素较敏感,而对头孢类耐药率较高;白色假丝酵母菌对两性霉素B的耐药率最低;金黄葡萄球菌对强力霉素和氯霉素耐药率较低,未发现万古霉素耐药株。结论老年下呼吸道感染患者的主要病原菌仍以G-杆菌为主,真菌感染明显增多;分离菌多重耐药现象严重,耐药性监测重要性凸显。     

细菌感染所致全身炎症反应综合征的病原学研究

目的 研究呼吸科细菌感染所致的全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)患者的病原学分布及耐药情况.方法 收集2006年10月至2007年10月北京大学第三医院呼吸科住院患者中符合SIRS诊断标准者632例,进行统计分析.结果 由于感染因素引起SIRS者376例(59.49%),非感染因素所致者256例(40.51%).感染因素中取得细菌学证据者76例(20.21%),革兰阴性杆菌和革兰阳性球菌分别是52例(68.42%)和24例(31.58%),其中前3位的病原菌是金黄色葡萄球菌[23.68%(18/76)]、铜绿假单胞菌[19.73%(15/76)]、鲍曼不动杆菌[15.78%(12/76)].结论 由感染性因素引起SIRS的主要致病菌为金黄色葡萄球菌和铜绿假单胞菌.     

呼吸机相关性肺炎的病原学调查

目的通过分析重症监护病房呼吸机相关性肺炎的病原学特点,对临床治疗提供依据。方法分析我院2003年9月~2004年8月重症监护病房收治的53例VAP患者的91株致病菌及其药物敏感情况。结果G-菌65例,占71.43%,以鲍曼不动杆菌,铜绿假单孢菌,阴沟肠杆菌为主,各占21.98%,17.58%,15.38%;G 菌22例,占24.18%,其中金黄色葡萄球菌占12.09%;真菌4例,占4.40%。多数细菌对抗生素耐药率较高。结论呼吸机相关性肺炎病原菌以G-菌为主且耐药率高,合理使用抗生素有助于预防和治疗VAP。     

Resistance in gram-negative bacilli in a cardiac intensive care unit in India: risk factors and outcome

The objective of this study was to compare the risk factors and outcome of patients with preexisting resistant gram-negative bacilli (GNB) with those who develop sensitive GNB in the cardiac intensive care unit (ICU). Of the 3161 patients ( n=3,161) admitted to the ICU during the study period, 130 (4.11%) developed health care-associated infections (HAIs) with GNB and were included in the cohort study. Pseudomonas aeruginosa (37.8%) was the most common organism isolated followed by Klebsiella species (24.2%), E. coli (22.0%), Enterobacter species (6.1%), Stenotrophomonas maltophilia (5.7%), Acinetobacter species (1.3%), Serratia marcescens (0.8%), Weeksella virosa (0.4%) and Burkholderia cepacia (0.4%). Univariate analysis revealed that the following variables were significantly associated with the antibiotic-resistant GNB: females (P=0.018), re-exploration (P=0.004), valve surgery (P=0.003), duration of central venous catheter (P<0.001), duration of mechanical ventilation (P<0.001), duration of intra-aortic balloon counter-pulsation (P=0.018), duration of urinary catheter (P<0.001), total number of antibiotic exposures prior to the development of resistance (P=0.014), acute physiology and age chronic health evaluation score (APACHE II), receipt of anti-pseudomonal penicillins (piperacillin-tazobactam) (P=0.002) and carbapenems (P<0.001). On multivariate analysis, valve surgery (adjusted OR=2.033; 95% CI=1.052-3.928; P=0.035), duration of mechanical ventilation (adjusted OR=1.265; 95% CI=1.055-1.517; P=0.011) and total number of antibiotic exposure prior to the development of resistance (adjusted OR=1.381; 95% CI=1.030-1.853; P=0.031) were identified as independent risk factors for HAIs in resistant GNB. The mortality rate in patients with resistant GNB was significantly higher than those with sensitive GNB (13.9% vs. 1.8%; P=0.03). HAI with resistant GNB, in ICU following cardiac surgery, are independently associated with the following variables: valve surgeries, duration of mechanical ventilation and prior exposure to antibiotics. The mortality rate is significantly higher among patients with resistant GNB.     

儿童社区获得性肺炎细菌病原学特点分析研究

目的：探讨儿童社区获得性肺炎（ CAP ）细菌病原学特点及药敏情况,指导临床肺炎诊治。方法系统分析956例住院CAP患儿的临床特征,细菌病原学特点和微生物敏感性试验情况。结果956例CAP患儿痰培养中革兰阴性（ G－）杆菌为653例,占68．3％;革兰阳性（ G＋）球菌为303例,占31．7％。主要有大肠埃希杆菌253例（26．5％）,肺炎克雷伯杆菌166例（17．4％）,流感嗜血杆菌78例（8．2％）,鲍曼不动杆菌53例（5．5％）,铜绿假单胞杆菌41例（4．3％）,肺炎链球菌47例（4．9％）和金黄色葡萄球菌41例（4．3％）。二级医院CAP常见病原为流感嗜血杆菌、卡他莫拉菌、肺炎链球菌;而三级医院则为大肠埃希杆菌、肺炎克雷伯杆菌、鲍曼不动杆菌、凝固酶阴性葡萄球菌。铜绿假单胞杆菌对泰能和美罗培南均有耐药,鲍曼不动杆菌对泰能有一定的耐药率。肺炎链球菌对青霉素、复方磺胺甲恶唑、克林霉素、红霉素及阿奇霉素均耐药。金黄色葡萄球菌对青霉素全耐药,对复方磺胺甲恶唑、氨苄西林、红霉素、阿奇霉素及四环素也有较高的耐药率。结论儿童CAP病原菌中革兰阴性杆菌并不少见,对抗菌药物耐药率高,需引起重视。