昆明地区儿童下呼吸道感染常见病原菌的分布和耐药性分析研究

目的:对儿童下呼吸道感感染病原菌的分布和主要变化进行统计和分析,并对各种病原菌的耐药特点和规律进行分析,指导临床对用药方案进行调整,提高临床诊治水平.方法:在昆明市妇幼保健院儿科2013年1月~2017年12月住院的下呼吸道感染患儿痰液培养所分离的所有病原菌及耐药趋势进行回顾性分析.结果:①病原菌总阳性率为9.91%,其中革兰阳性菌检出率为58.86%,革兰阴性菌检出率为40.46%,真菌检出率为0.69%;所检出的病原菌前五位分别为肺炎链球菌、金黄色葡萄球菌、大肠埃希菌、流感嗜血杆菌、卡他莫拉菌;检出阳性细菌每年均以肺炎链球菌为第一位,大肠埃希菌的检出率有逐年下降趋势,流感嗜血杆菌和卡他莫拉菌的检出率有逐年上升趋势.②肺炎链球菌和金黄色葡萄球菌对万古霉素及利奈唑胺最敏感,大肠埃希菌对碳青霉烯类最敏感,流感嗜血杆菌和卡他莫拉菌对头孢类抗生素均敏感.结论:儿童下呼吸道感染致病菌以革兰阳性球菌为主,检出率较高的细菌有肺炎链球菌、金黄色葡萄球菌、大肠埃希菌、流感嗜血杆菌、卡他莫拉菌.不同细菌对常用抗生素的敏感率不同.临床应以微生物培养及药敏试验为依据,合理选用抗生素,减缓耐药菌株的产生.

Distribution and drug resistance of common pathogens in children with lower respiratory tract infection in Kunming

Objective:To guide the clinical adjustment of drug use program and improve the level of clinical diagnosis and treatment,drug resistance characteristics and distributionof bacteria were analyzed.Methods:Retrospective analysis were performed for all bacteria isolated from sputum culture of children with lower respiratory tract infection hospitalized in pediatrics department of Kunming city maternal and child health hospital from January 2013 to December 2017 to analyze the drug resistance trend.Results:(1)the total positive rate of pathogenic bacteria was 9.91%,among which the positive rate of Gram-positive bacteria was 58.86%,the negative rate of Gramnegative bacteria was 40.46%,and the positive rate of fungi was 0.69%;The top five pathogens were Streptococcus pneumoniae,Staphylococcus aureus,Escherichia coli,Haemophilus influenzae and catamora;Streptococcus pneumoniae is the highest detection rate every year.The detection rate of Escherichia coli is decreasing year by year.The detection rate of Haemophilus influenzae and catamoraxella is increasing year by year.(2)Streptococcus pneumoniae and Staphylococcus aureus are most sensitive to vancomycin and linezolid,Escherichia coli is most sensitive to carbapenems,Haemophilus influenzae and Catamora are sensitive to cephalosporins.Conclusion:Gram positive cocci were the main pathogens of children's lower respiratory tract infection.The bacteria with high detection rate were Streptococcus pneumoniae,Staphylococcus aureus,Escherichia coli,Haemophilus influenzae and catamora.Different bacteria had different sensitivity to common antibiotics.In order to slow down the production of drug-resistant strains,antibiotics should be selected reasonably on the basis of microbial culture and drug sensitivity test.