279例儿童下呼吸道感染病原菌分布及耐药性分析

目的了解儿童呼吸道感染患者的病原学特点及病原菌耐药情况，指导临床合理用药。方法回顾性分析2008年1月-2010年12月本院儿科住院呼吸道感染患者的痰培养结果。结果935例痰培养标本中检出279株致病菌，阳性率为29．8％，其中G-菌占67．7％、G’菌占22．9％、真菌占9．3％。以大肠埃希氏菌、肺炎克雷伯氏、金黄色葡萄球菌和肺炎链球菌为主要细菌，革兰氏阳性球菌对万古霉素、米诺四环素、替考拉宁和利福平较为敏感，而革兰氏阴性杆菌对美洛培南、亚胺培南和阿米卡星的敏感性较高。常见G＋、G-菌的耐药性有上升趋势，且具有多重耐药性。结论住院患儿下呼吸道感染的病原茵仍以革兰阴性菌为主，但多药耐药的细菌及真菌的分离率呈上升趋势。在治疗儿科感染性疾病时应依据药敏试验结果合理使用抗生素，以减少耐药菌株产生。

Pathogen Distribution and Antibiotic Resistance in 279 Children With Lower Respiratory Tract Infection

Objective To investigate the pathogenic change in children with lower respiratory tract infection （RTI） and to provide reference for clinical treatment. Methods Retrospective analysis was conducted on sputum culti-vation resuhs of RTI children who were hospitalized from January 2008 to December 2010. Results 279 strains were isolated from 935 samples, positive rate was about 29.8%. Gram-positive microorganisms accounted for 22.9% （64） of the positive culture results, Gram-negative microorganisms accounted for 67.7% （ 189 ）, and fungi accounted for 9.3% （26）. The main pathogens were Eseherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae. The sensitive drugs of Gram-positive microorganisms were vancomycin, rifampicin, teicoplanin and minocyline. While the sensitive drugs of Gram-negative microorganisms were Meropenem imipenem, and amikaein. The drug resistance rate was increasing and some bacteria were multi drug resistance strains. Conclusion Gram-negative bacilli are still the primary pathogens resuhing in lower respiratory tract infection in children. Fungi and muti-drug-resistant bacteria are on the rise trend. In order to reduce drug resistance strains, it is important that bacterial culture should be carried out actively and antibiotics administration must be based on the drug sensitivity test of clinical significance.