1 613例儿童社区获得性肺炎的病原菌变迁及耐药特点

目的:分析重庆医科大学附属儿童医院近10年来儿童社区获得性肺炎(CAP)病原学检测结果,了解CAP病原变迁及耐药情况。方法:回顾性分析该院2014年1-12月住院治疗的1 613例CAP患儿鼻咽抽吸物(或痰液标本)细菌培养、呼吸道7种病毒及支原体检查结果等资料。结果:(1)检出前2位细菌为副流感嗜血杆菌、肺炎链球菌;与2003年及2009年比较,副流感嗜血杆菌、肺炎链球菌检出比增加,流感嗜血杆菌检出比显著减少。婴儿组肺炎克雷伯菌肺炎亚种检出比下降。(2)与2003年及2009年相比,各年龄组腺病毒及支原体检出率增加。(3)病原菌对常用抗生素耐药率有一定程度增高,肺炎链球菌对青霉素耐药率显著下降,为肺炎链球菌敏感药物。结论:儿童CAP病原构成和病原菌耐药性随时间发生变迁,所检出病原菌对常用抗生素有不同程度耐药,做好地区病原及药敏监测,有助于合理选用抗菌药物。

Changes of Pathogen and Antimicrobial Resistance of 1, 613 Children with Community Acquired Pneumonia

Objective: To investigate the results of pathogen detection in recent ten years of Chongqing Medical University, study the changes of pathogen and antimicrobial resistance status in children with community acquired pneumonia (CAP) . Methods: Nasopharyngeal aspirates or sputum specimens of 1,613 children with CAP were collected from January to December 2014, the bacterial culture, 7 respiratory viruses, mycoplasma were tested. The data were retrospectively analyzed. Results: (1) The predominant bacteria were Hemophilus parainfluenzae and Streptococcus pneumonia. The detected rates of the two bacteria were increased in combination with those of 2003 and 2009, Haemophilus influenzae decreased, Klebsiella pneumoniae pneumonia in infant group decreased. (2) The detected rates of Mycoplasma and Adenovirus (ADV) were higher than those of 2003 and 2009 in all age groups. (4) Antimicrobial resistance of bacteria increased by year. The resistant rate of Streptococcus pneumoniae to penicillin reduced significantly, making it a sensitive drug. Conclusion: The pathogen and antimicrobial resistance of children with CAP change with time. The selection of antibiotics should be based on etiology and drug susceptibility test.