小儿社区获得性下呼吸道感染病原菌及耐药性分析

目的 了解儿童社区获得性下呼吸道感染的病原菌分布及耐药性,为临床诊断和合理用药提供依据.方法 对1 359例住院患儿下呼吸道痰标本进行细菌培养和药敏试验.结果 1 359例痰标本中共分离出病原菌622株,以革兰氏阳性菌为主共414株占66.6%,革兰氏阴性菌205株占32.9%,真菌3株占0.5%.革兰氏阳性菌中以肺炎链球菌和金黄色葡萄球菌为主,两种菌对红霉素、克林霉素耐药率为68.8%～88.5%,金黄色葡萄球菌对青霉素耐药率为97.5%.革兰氏阴性菌以卡他莫拉菌、肺炎克雷伯菌、大肠埃希菌为主,卡他莫拉菌对青霉素耐药率为72.6%,肺炎克雷伯菌和大肠埃希菌对氨苄西林、哌拉西林耐药率高为69.8%～98.3%,对β-内酰胺酶抑制剂复合剂、喹诺酮类、碳青霉烯类、三代头孢菌素（头孢他啶、头孢替坦）及四代头孢菌素敏感.结论 革兰氏阳性菌为小儿社区获得性下呼吸道感染的主要致病菌,常见病原菌对抗菌药物的耐药性日趋严重,应重视对病原菌及细菌耐药性的监测,合理使用抗生素.     

潍坊地区儿童下呼吸道感染病原菌分布与耐药性分析

目的 了解本地区儿童社区获得性下呼吸道感染致病菌的分布及耐药情况,为临床抗菌药物的选择提供指导.方法 对我院儿科2010年7月至2011年7月因下呼吸道感染住院治疗患儿的合格痰标本进行细菌学培养,用法国生物梅里埃全自动微生物分析系统(VITEK32)进行细菌鉴定及药敏诊断系统进行细菌菌株鉴定及药物敏感性检测.结果 473份合格痰标本中共分离到320株致病菌株,其中革兰阳性菌174株,占54.4%;革兰阴性菌134株,占41.8%,真菌12株,占3.8%.其中最常见的前七位致病菌分别为肺炎链球菌(20.6%)、大肠埃希菌(13.4%)、金黄色葡萄球菌(13.1%)、铜绿假单胞菌(8.8%)、表皮葡萄球菌(8.1%)、肺炎克雷伯菌(6.3%)、鲍曼不动杆菌(5.0%).全部革兰氏阳性菌及阴性菌均对亚胺培南敏感,全部革兰氏阳性菌对万古霉素敏感,对氨基糖苷类、喹诺酮类、β-内酰胺酶抑制剂类抗菌药敏感性较好,对头孢类药物均有不同程度耐药.结论 本地区小儿社区获得性下呼吸道感染的主要致病菌为革兰阳性菌,对β-内酰胺类抗菌药物不同程度耐药,治疗应根据痰培养病原菌种类及药物敏感性试验结果.     

婴幼儿社区获得性肺炎细菌病原学检测结果分析

目的分析婴幼儿社区获得性肺炎(Community Acquired Pneumonia,CAP)的细菌病原学分布,为抗生素的经验选择提供参考。方法于入院当天使用抗生素前留取下呼吸道分泌物进行一般细菌鉴定,对鉴定结果进行分析。结果 256例婴幼儿CAP下呼吸道分泌物中检出病原菌148株,检出率为57.8%,其中肺炎链球菌44株(29.73%),流感嗜血杆菌36株(23.65%)、肺炎克雷伯菌22株(14.86%)、金黄色葡萄球菌13株(8.78%)、大肠埃希菌11株(7.43%)、卡他莫拉菌9株(6.08%)、铜绿假单胞菌6株(4.05%),其他菌7株(4.73%)。肺炎链球菌、金黄色葡萄球菌和卡他莫拉菌和年龄无关,差异无统计学意义(P0.05);但幼儿感染流感嗜血杆菌和大肠埃希菌的机会明显高于婴儿,差异有统计学意义(P0.05)。结论肺炎链球菌、流感嗜血杆菌和肺炎克雷伯菌是本地区婴幼儿CAP的主要细菌病原菌,可作为儿科医师经验性选药时的参考依据。     

我院2012年儿科呼吸道标本519株病原菌分布及耐药性监测结果

目的了解我院2012年儿科呼吸道标本分离病原菌分布及对常用抗菌药物的耐药性。方法采用Whonet 5.6软件对我院2012年儿科呼吸道标本分离菌株进行统计分析。结果 2012年我院儿科呼吸道标本共分离病原菌株519株,其中革兰阳性菌占38.9%(202/519),革兰阴性菌占61.1%(317/519)。主要为流感嗜血杆菌、肺炎链球菌和卡他莫拉菌、金黄色葡萄球菌、大肠埃希菌及肺炎克雷伯菌,分别占32.8%、24.3%、16.4%、14.3%、4.8%及2.5%。药敏试验结果显示PRSP检出率为6.3%(8/126),流感嗜血杆菌和卡他莫拉菌β-内酰胺酶阳性率分别为46.5%和96.3%;MRSA检出为58.1%(43/74);大肠埃希菌和肺炎克雷伯菌ESBLs阳性率分别为44.0%(11/25)和23.1%(3/13)。结论流感嗜血杆菌、肺炎链球菌和卡他莫拉菌是引起儿童呼吸道感染的主要病原菌,重视儿童呼吸道标本的采样和培养是提高儿童呼吸道病原菌分离率的关键,定期对儿童呼吸道分离病原菌进行耐药性监测有助于了解其耐药性的变迁,为临床经验用药提供依据,对加强儿童抗菌药物合理应用的监督和管理起到积极的作用。     

重症监护室病人下呼吸道感染病原菌的分布与耐药性分析

目的:探讨重症监护室(ICU)下呼吸道感染病原菌的分布与耐药状况,为临床上合理用药提供参考数据。方法:对我院ICU1年内住院病人下呼吸道的痰标本细菌培养结果进行回顾性分析。结果:本研究共分离出97株病原菌;其中62株(63.9%)为革兰氏阴性菌;26株(26.8%)为革兰氏阳性菌;7株(7.2%)为真菌。革兰氏阳性菌主要为金黄色葡萄球菌;革兰氏阴性菌主要有鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌以及铜绿假单胞菌。结论:ICU发生下呼吸道感染主要为革兰氏阴性杆菌,药敏试验结果表明多数细菌显示出多重耐药性。临床上应参照药敏试验结果合理应用抗菌药物,避免产生耐药菌株。     

儿童呼吸道感染病原菌分布与耐药性研究

目的 探讨儿科患者呼吸道感染主要病原菌分布及其对常用抗菌药物的耐药情况.方法 对2007年11月-2008年5月冬春季节北京大兴区人民医院儿科呼吸道感染患儿鼻咽分泌物分离的49株肺炎链球菌、35株流感嗜血杆菌和27株卡他莫拉菌,采用Kirby-Bauer(KB)法进行抗菌药物敏感性检测.结果 3种细菌检出率比较,差异有统计学意义(P＜0.05,).49株肺炎链球菌对红霉素的耐药率高达91.8%(45/49),对青霉素不敏感菌9株,不敏感率为18.4%,多重耐药率高达53.0%;35株流感嗜血杆菌对复方磺胺甲口恶唑耐药率为85.7%(30/35),对氨苄西林和氯霉素敏感.卡他莫拉菌产酶率为66.7%,对氨苄西林和红霉素的耐药率均达到77.8%(21/27).结论 儿童呼吸道感染常见致病菌中肺炎链球菌对红霉素的耐药性很高;流感嗜血杆菌对氨苄西林敏感;卡他莫拉菌对氨苄西林和红霉素的耐药性很高.儿童呼吸道细菌感染时,应尽量避免使用非β-内酰胺类抗菌药物.应尽量根据药敏结果合理使用抗菌药物.     

反相杂交技术在常见社区获得性肺炎致病菌基因诊断研究中的应用

目的：采用核酸反相杂交技术检测常见社区获得性肺炎致病菌。方法：用16SrRNA基因通用引物扩增细菌371bP片段，将通用探针和特异探针固定于硝酸膜上，通过反相杂交技术对肺炎锭球菌、流感嗜血杆菌、卡他莫拉菌进行诊断，并与常规痰培养结果比较。结果：100份合格痰标本中检出细菌75株，革兰阳性菌31株，革兰阴性菌44株，其中肺炎链球菌15株，流感嗜血杆菌9株，卡他莫拉菌4株，均优于传统的痰培养方法。结论：反相杂交技术对致病菌的诊断准确可靠，经济快速，是临床诊断的可靠工具。     

小儿社区获得性肺炎致病菌感染现状及药敏分析

目的:了解我地区小儿社区获得性肺炎患儿致病菌感染情况及耐药性。方法:对送检合格的699份痰液标本进行培养及药敏试验。结果:699份痰液标本分离出病原菌365株,总阳性率52.2%,其中革兰氏阴性菌,革兰氏阳性菌,真菌分别为65.2%,26.3%,8.4%。主要致病菌依次为肺炎克雷伯菌69株,阴沟肠杆菌42株,真菌31株,大肠埃希菌23株,金黄色葡萄球菌20株,铜绿假单胞菌7株。主要致病菌对多种抗生素呈现高比例耐药,未检出亚胺培南耐药。结论:小儿社区获得性肺炎致病菌以革兰氏阴性菌为主,对常用抗生素产生了耐药。痰培养结果有利于指导临床用药,减少细菌耐药性。     

儿童急性下呼吸道感染细菌病原学分析

目的 探讨儿童急性下呼吸道感染细菌病原学特点.方法 780例确诊急性下呼吸道感染患儿,痰液送检细菌培养,用K-B法行药敏试验.结果 分离出细菌220株(28.2%).其中,金黄色葡萄球菌43株(19.5%),肺炎克雷伯菌41株(18.6%),铜绿假单胞菌26株(11.8%),大肠杆菌22株(10%),流感嗜血杆菌21株(9.5%),鲍曼不动杆菌14株(6.4%),卡他莫拉菌11株(5%),白念珠菌11株(5%),产气肠杆菌7株(3.2%),肺炎链球菌3株(1.4%),阴沟肠杆菌3株(1.4%),G群链球菌3株(1.4%),其他酵母样真菌3株(1.4%),化脓链球菌2株(0.9%),副流感嗜血杆菌2株(0.9%),其他细菌8株(3.6%).低年龄组分离的阳性率较年长儿高.金黄色葡萄球菌各年龄组均有发病.肺炎克雷伯菌、铜绿假单胞菌、大肠杆菌、流感嗜血杆菌、鲍曼不动杆菌以3岁以下患儿为多.结论 金黄色葡萄球菌和肺炎克雷伯菌是儿童急性下呼吸道感染主要病病菌.     

小儿呼吸道感染常见病原菌分布及其耐药性

目的:了解小儿急性呼吸道感染常见病原菌分布及对抗菌药物的耐药性,为临床合理用药提供依据。方法:对2011年1月~2012年12月儿科送检的呼吸道感染患儿的咽拭子标本所分离的病原菌进行细菌鉴定和药敏试验。结果:共分离出501株病原菌,其中革兰氏阴性菌320株,占63.9%,革兰氏阳性菌148株,占29.5%,真菌33株,占6.6%。革兰氏阳性菌前3位为:金黄色葡萄球菌、化脓性链球菌、乙型链球菌;革兰氏阴性菌前三位为:鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌。革兰氏阴性菌耐药率高,亚胺培南等最敏感,万古霉素等对革兰氏阳性菌最敏感。结论:小儿呼吸道感染病原以革兰氏阴性菌为主,其药敏结果说明耐药性较高,临床应合理用药,减少耐药性产生。     

Clinical course and background of nasopharyngeal antibiotic-resistant bacteria carriers among preschool children hospitalized for lower respiratory tract infection

We investigated the nasopharyngeal microbiota in preschool patients hospitalized with lower respiratory tract infection to clarify the relationships between culturable nasopharyngeal bacteria and prognosis. From 2016 to 2018, nasopharyngeal culture was performed on inpatients under 6 years of age with a lower respiratory tract infection. Among the 1,056 study patients, 1,046 provided nasopharyngeal samples that yielded positive cultures, yielding 1,676 isolated strains. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, were isolated in 25%, 27%, and 31% of the samples, respectively, and were the major causes of respiratory tract infection in these children. The only factor associated with the isolation of antibiotic-resistant strains from the nasopharynx was daycare attendance, which did not affect clinical severity, such as duration of fever and hospitalization. This study demonstrated that resistant bacteria in the nasopharynx did not affect the severity of lower respiratory tract infection and supports the use of narrow-spectrum antimicrobial agents in accordance with published guidelines when initiating therapy for pediatric patients with community-acquired pneumonia.     

海口市儿童急性下呼吸道细菌感染的病原学特征及耐药性分析

目的统计分析本院住院儿童急性下呼吸道细菌感染的病原学分布及耐药情况,为临床合理应用抗生素提供参考依据。方法对本院2020年送检的5394例急性下呼吸道感染的住院儿童的痰液标本进行培养鉴定,并对菌株进行药敏试验。应用Excel表格和WHONET系统进行数据统计分析。结果5394份痰液标本共分离出501株细菌,阳性率为9.3%;其中检出革兰阴性菌337株,占67.3%;检出革兰阳性菌158株,占31.5%;检出真菌6株,占1.2%。排名前七的细菌依次为流感嗜血杆菌,肺炎链球菌,肺炎克雷伯菌,金黄色葡萄球菌,大肠埃希菌,卡他莫拉菌,鲍曼不动杆菌。新生儿科菌群分布以肺炎克雷伯菌,大肠埃希菌,金黄色葡萄球菌为主;儿科菌群分布以流感嗜血杆菌,肺炎链球菌,金黄色葡萄球菌为主。药敏结果显示:流感嗜血杆菌的β-内酰胺酶阳性率为64.04%,对氨苄西林和复方新诺明的耐药率均高于78.0%,对阿奇霉素的耐药率为28.09%,而对头孢他啶、头孢曲松、左氧氟沙星、美罗培南、阿莫西林/棒酸的耐药率均低于1.12%。肺炎链球菌对红霉素的耐药率高达98.68%,对复方新诺明,四环素的耐药率均高于80.0%,没有发现对青霉素耐药的肺炎链球菌。金黄色葡萄球菌对青霉素耐药率为90.0%,对红霉素和克林霉素的耐药率菌均高于35.0%,MRSA的检出率为15.0%,未发现对万古霉素耐药的金黄色葡萄球菌。肺炎克雷伯菌和大肠埃希菌对头孢唑林的耐药率均高于90.0%、对复方新诺明的耐药率均高于40.0%、对头孢曲松的耐药率均高于其他三代头孢,两种细菌的碳青霉烯酶阳性率分别为2.82%和1.85%,ESBLS阳性率分别为15.49%和7.40%。卡他莫拉菌的β-内酰胺酶阳性率为92.73%,对红霉素、克拉霉素、阿奇霉素、复方新诺明的耐药率均高于20.0%。结论儿童急性下呼吸道感染的病原菌以流感嗜血杆菌和肺炎链球菌为主;病原菌对红霉素、氨苄西林、复方新诺明、青霉素、阿奇霉素、头孢曲松等常用抗生素的耐药性较高且因病原体而异,在临床治疗的过程中,应当结合病原菌的药敏结果,选择恰当的药物治疗。     

Nasopharyngeal colonization by Moraxella catarrhalis and study of antimicrobial susceptibility in healthy children from Cuban day-care centers

The prevalence of nasopharyngeal carriage of Moraxella catarrhalis was determined for the first time in Cuba. One-hundred fifty healthy children attending three day-care centers in the municipality of Marianao, Havana City were studied. The percentage of recovering bacteria in nasal and pharyngeal swabs was compared. Antimicrobial susceptibilities to ampicillin, trimethoprim-sulfamethoxazole, tetracycline, cefotaxime, ceftriaxone, chloramphenicol, erythromycin, azithromycin, amoxicillin/clavulanate, and norfloxacin were determined by the disk diffusion method according to recommendations of the National Committee for Clinical Laboratory Standards. Sixty-five percent of the children studied carried Moraxella catarrhalis. The nasal cavity was the main isolation site for this organism (81% of positive cultures). Most strains were highly susceptible to the antimicrobial agents tested, except to ampicillin (53.6% resistance). This study provides evidence of the need for continued surveillance of antimicrobial susceptibility of Moraxella catarrhali, in order to determine optimal empiric therapy for community-acquired respiratory tract infections produced by this pathogen.     

2010-2012年度儿童下呼吸道感染的病原菌及耐药性分析

目的 探讨儿童下呼吸道感染的病原学特点及药物敏感性,指导临床合理使用抗生素.方法 2010年10月-2012年11月间在该院儿科住院的下呼吸道感染的呼吸道分泌物标本中分离病原菌并进行药物敏感性监测.结果 614份呼吸道分泌物标本中共分离出105株病原菌,阳性率为17.11％,其中G-菌73株,占69.52％,G＋球菌32株,占30.48％.革兰阴性菌中,第3位分别为大肠埃希菌26株（占35.62％）,肺炎克雷伯菌23株（31.51％）,流感嗜血杆菌11株（15.07％）.革兰阳性菌中金色葡萄球菌感染率最高.G-菌对阿米卡星、亚胺培南、哌拉西林/他唑巴坦均敏感.G＋菌耐药率低,头孢类抗生素普遍敏感.结论 该地区儿童下呼吸道感染的病原菌以G-菌为主,且对常用抗生素有不同程度的耐药,提醒临床医生应依据药敏试验结果合理选择抗菌药物.     

Use of antimicrobial agents for upper respiratory tract infections in Taiwanese children

Upper respiratory tract infections (URTIs) are mostly caused by viruses. Antibiotic misuse for viral URTIs in children is a serious problem that not only results in selection of resistant strains of bacteria but also wastes millions of dollars each year in Taiwan. Antibiotic resistance among common respiratory bacterial pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis has become a major issue for public health. The common cold, acute pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, influenza and acute epiglottitis are the most frequently encountered acute URTIs in out-patient clinics. This article recommends the judicious use of antimicrobial agents for these seven common pediatric URTIs, based on local epidemiological data and the recommendations of the Infectious Disease Society of Taiwan and the American Academy of Pediatrics. With education and behavior modification, practitioners will help to reduce antibiotic overuse, and the goal of reducing antimicrobial resistance may be accomplished.     

小儿下呼吸道感染的病原菌分析

目的了解小儿下呼吸道感染的病原菌种类及其药物敏感性,指导临床合理用药。方法对526例下呼吸道感染住院患儿做痰培养及药敏试验,并对痰培养阳性的132例进行病原菌及药敏分析。结果病原菌检出率25．1％。检出革兰阴性细菌85株(占64．4％),革兰阳性细菌47株(占35．6％)。其中大肠埃希菌(18．9％)、肺炎克雷伯菌(13．6％)、表皮葡萄球菌(9．8％)、铜绿假单胞菌(9．1％),溶血葡萄球菌(8.3％)为主要菌株。所有革兰阴性菌对亚胺培南敏感。结论大肠埃希菌、肺炎克雷伯菌为小儿下呼吸道感染的主要致病菌,亚胺培南、头孢吡肟对革兰阴性菌敏感。     

卡他莫拉氏菌在下呼吸道感染中的发病情况和对抗生素的敏感性

本文报告了１９９２年４月～１９９２年１２月在我院呼吸病房住院诊断为下呼吸道感染的２０３例，分离出致病菌１３５株，其中莫拉氏菌３０株，占２２．２％，仅次于绿脓杆菌（２３．７％），居第二位。３０例莫拉氏菌感染中，２１例有原发疾病，其中１８例为ＣＯＰＤ。对３０株莫拉氏菌进行药敏感试验，结果表明其对麦迪霉素、红霉素、青霉素、氨苄青霉素、先锋Ｖ、磺苄青霉素的耐药率达５０％以上。对头孢噻肟钠、庆大霉素的耐药率分别为３３．３％与４０％。而对优立新（氨苄青霉素／青霉烷砜）、噻比达（先锋必／青霉烷砜）、环丙沙星、头孢哌酮和丁胺卡那的耐药率＜２０％。     

Branhamella (Moraxella) catarrhalis: pathogenic significance in respiratory infections

OBJECTIVES: To assess the pathogenic significance of Branhamella catarrhalis isolates in patients with respiratory infections and to define the clinical characteristics of such patients. DESIGN and SETTING: Respiratory specimens were assessed in a three-year prospective study performed in a Brisbane metropolitan hospital. Assessment of the pathogenic significance of isolates of B. catarrhalis was based on four predetermined criteria: (i) clinical evidence of respiratory infection based on history, examination and chest x-ray; (ii) isolation of B. catarrhalis as the sole potential pathogen; (iii) absence of antibiotic treatment in the previous two weeks; and (iv) subsequent clinical response to an antibiotic to which the isolate was sensitive. RESULTS: B. catarrhalis was identified in 118 respiratory samples, 92 (78%) being from patients less than 10 years old. Infection with B. catarrhalis was more commonly seen in winter months and was community-acquired in two-thirds of cases. Isolation of this organism was associated with a broad variety of upper and lower respiratory tract syndromes. Isolates were considered to be of pathogenic significance (all four above criteria satisfied) in 35% of cases and of possible significance (the first and fourth criteria satisfied) in a further 15% of cases. Isolates were more likely to be of pathogenic significance in older patients and in those with pre-existing cardiorespiratory disease; however, a number of serious infections were observed in previously-well children. Expectorated sputum and tracheal aspirates were more likely to yield a clinically significant isolate than nasopharyngeal aspirates. Production of beta-lactamase was demonstrated in 88% of isolates. CONCLUSION: B. catarrhalis causes respiratory infection more frequently than is generally appreciated. Isolation of this organism from the respiratory tract had pathogenic significance or possible pathogenic significance in 50% of our patients. If therapy is indicated in patients with respiratory infection caused by this organism, traditional beta-lactam regimens cannot be relied upon, as shown by the high rate of beta-lactamase production in this study; a tetracycline, erythromycin, a second or third generation cephalosporin, or the combination of a penicillin derivative and beta-lactamase inhibitor should be considered.     

云南省HIV/AIDS患者下呼吸道感染病原菌分布及耐药分析

目的：研究云南省HIV/AIDS合并下呼吸道感染住院患者病原菌分布及耐药性特点,指导临床用药．方法收集2008年1月至2012年12月在昆明市第三人民医院艾滋病科住院的HIV/AIDS合并下呼吸道感染住院患者278例进行痰液,肺泡灌洗液标本涂片、培养,阳性标本进行回顾性分析．结果278例痰液及肺泡灌洗液标本共分离出细菌127株（45.7%）,真菌53株（19.1%）,白色假丝酵母菌50株,曲霉菌3株．分支杆菌49株,结核分枝杆菌44株,其余为非典型分支杆菌．革兰氏阴性杆菌占64.6%,依次为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、不动杆菌属、阴沟肠杆菌,革兰阳性菌占15.4%．真菌占19.1%,常见为白色念珠菌．结核分枝杆菌占17.6%．革兰阴性杆菌对亚胺培南、头胞哌酮/舒巴坦、阿米卡星较敏感,革兰阳性菌对万古霉素、呋喃妥因、亚胺培南较敏感．结论云南省HIV/AIDS患者合并下呼吸道感染病原菌主要为革兰阴性杆菌,真菌感染比例逐年增高,以条件致病菌为主,对抗菌药物产生了不同程度的耐药,结核杆菌感染发病率高,存在耐多药结核菌,临床应合理使用抗菌药物,以延缓病原菌耐药的产生．