2008至2010年兰州地区5岁及以下儿童社区获得性肺炎细菌病原学调查及耐药性分析

目的 了解2008至2010年兰州地区≤5岁儿童社区获得性肺炎(CAP)的病原菌分布和细菌耐药情况,为临床经验性治疗提供参考依据.方法 2008年8月至2010年8月,对≤5岁的CAP住院患儿610例,采集呼吸道标本共计610例进行细菌培养及药敏检测,并对结果进行统计学分析(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象监护人的知情同意,与其签署临床研究知情同意书).结果 610例患儿中,细菌培养呈阳性标本为197例,细菌为211株,阳性率为32.3%.其中,革兰阴性(G-)菌株为127株(60.2%).革兰阳性(G+)菌株为84株(39.8%).分离菌株依次为:大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、阴沟肠杆菌及肺炎链球菌.检出的前3位G-菌对抗菌药物氨苄西林、哌拉西林及第二、第三代头孢菌素的耐药率较高,而对亚胺培南、阿米卡星敏感性较高.检出的前3位G+菌对青霉素、氨苄青霉素、红霉素的耐药率极高,而对万古霉素、奎奴普汀及利奈唑胺100.0%敏感.结论 兰州地区儿童CAP分离菌株中,G菌明显多于G+菌,分离菌株对常用抗菌药物的耐药率较高.

Pathogens and Antibiotic Resistance of Community-Acquired Pneumonia in Children Aged Under 5 Years Old in Lanzhou

Objective To investigate the pathogens and antibiotic resistance of community-acquired pneumonia(CAP) in children aged under 5 years old in Lanzhou.Methods A total of 610 CAP cases of hospitalized children in the Department of Pediatrics,Lanzhou University Second Hospital from August 2008 to August 2010 were included in this study.Actualized sputum culture,test of drug sensitivity and statistical analysis were conduct.Results In the 610 cases,211 specific pathogens were identified in 197 cases(32.3%).It included 127 cases(60.2%) of Gram-negative(G-) bacteria and 84(39.8%) of Gram-positive(G+) bacteria.Among them,the main bacteria were Escherichia coli,Staphylococcus aureus,Klebsiella pneumoniae,Enterobacter cloacae and Streptococcus pneumoniae Coli.Drug resistance of the main G-bacilli to ampicillin,piperacillin,second and third generation cephalosporin were particularly common,while imipenem and amikacin presented high sensitivity.For the G+ cocci,penicillin,penbritin and erythromycin had high drug resistance rate,but vancomycin,quinupristin and linezolid showed 100.0% sensitivity.Conclusions The dominant pathogens during the recent two years in this region for the hospitalized children with CAP is G-bacilli,and it showed the high drug resistance rate.