405株儿童革兰阴性杆菌呼吸道感染的病原菌分布及药敏分析

目的对儿童呼吸道感染的革兰阴性杆菌的分布及药敏情况进行回顾性分析,以指导临床合理使用、选用抗菌素。方法对2010年1月-2011年1月湖南省人民医院儿科住院部儿童呼吸道感染送检分离的氧化酶阴性的革兰阴性杆菌及其药敏进行统计分析。结果 405株17种革兰阴性杆菌中,5种主要病原菌的分布情况是:肺炎克雷伯菌176株(43.46%),大肠埃希菌169株(41.73%),产气肠杆菌15株(3.7%),产酸克雷伯菌10株(2.47%),阴沟肠杆菌9株(2.22%)。其中肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs,extended spectrum beta-lactamases)检出率分别达54.55%和73.96%,ESBLs检出率在肠杆菌科不同菌种中差异有统计学意义(χ2=14.07>χ20.005,2,P<0.005)。药敏结果显示:所选的20种抗菌药物中,对革兰阴性杆菌敏感性较高的抗菌药物有亚胺培南、美罗培南、头孢哌酮/舒巴坦、头孢吡肟,耐药性较高的有青霉素类,第一、第二、第三代头孢菌素。结论儿童革兰阴性杆菌呼吸道感染以肺炎克雷伯菌和大肠埃希菌为主,且细菌耐药性严重,应依据药敏试验结果合理选择抗菌药物。

Analysis on Distribution and Drug Resistance of 405 Strains of Gram - negative Bacilli from Children with Respiratory Tract Infection

Objective To make a retrospective analysis on the distribution and drug resistance of Gram-negative bacilli from children with respiratory tract infection,so as to provide a basis for rational selection and proper use of antibiotics.Methods The distribution and drug resistance of oxidase negative Gram-negative bacilli isolated from sputum specimens of inpatients hospitalized in Department of Pediatrics,Hunan Provincial People＇s Hospital during January 2010 to January 2011 were analyzed.Results The 405 isolated strains belonged to 17 kinds of Gram-negative bacilli.The distribution of the top five pathogens was as follows： 176 strains of Klebsiella pneumoniae（43.46%）,169 Escherichia coli（41.73%）,15 Enterobacter aerogenes（3.7%）,10 Klebsiella oxitoca（2.47%）,and 9 Enterobacter cloacae（2.22%）.The proportions of Klebiella pneumoniae and Escherichia coli producing extended spectrum β-lactamases（ESBLs） were 54.55% and 73.96%,respectively.The detection rates of ESBLs in different strains of Enterobacteriaceae varied significantly（P0.005）.The drug sensitivity tests showed that among 20 tested antibiotics,Gram-negative bacilli were sensitive to imipenem,meropenem,cefoperazone and amikacin,while they were highly resistant to penicillin and the first-,second-and third-generation of cephalosporins.Conclusions The major pathogens causing Gram-negative bacilli infection in the respiratory tract of children are Klebsiella pneumoniae and Escherichia coli.The drug resistance of the bacteria is serious.Selection of antibiotics should be based on the drug sensitivity tests.