小儿肺炎致病菌及其耐药性的回顾与分析

目的：了解我院小儿致病菌的现状，并对细菌耐药性及多重耐药菌和院感危险因素进行分析，以指导临床防治。方法：回顾性查阅病历，收集2012年3月-2013年2月间小儿肺炎痰培养阳性的临床及实验室资料，对结果进行统计学分析。结果：小儿肺炎痰培养分离致病菌282株，致病菌以革兰氏阴性杆菌为主220株（78．0％），革兰氏阳性菌61株（21．6％），真菌1株（0．4％），其中肺炎克雷伯菌88株（31．2％）、大肠埃希菌79株（28．0％）为最主要致病菌，两者均有较明显的耐药及多重耐药现象。对亚胺培南敏感率仅为79％、81％，对头孢哌酮/舒巴坦敏感率为69％、74％，主要对氧氟沙星、环丙沙星、阿米卡星敏感率高为85％～96％，而对常用抗菌药物头孢他啶、头孢噻肟钠、头孢曲松敏感率为38％～59％，肺炎克雷伯和大肠埃希菌产超广谱β-内酰胺酶（ESBLs）的比例为（43/88、41/79），ESBLs阳性菌株对三代头孢菌素均有＞80％的耐药率。院感和多重耐药菌的危险因素有：年龄小、存在基础疾病、免疫力低下、反复呼吸道感染、使用3种或3种以上抗生素、使用抗生素≥14d。结论：我院小儿肺炎致病菌主要为条件致病菌，以革兰氏阴性杆菌为主，致病菌对常用青霉素、头孢菌素类耐药率较高，对头孢曲松、β-内酰胺酶抑制、亚胺培南等高级抗生素敏感率不理想，应引起临床医师高度重视，必须严格限制使用具有高潜在耐药性的一类抗菌药物。

Review and Analysis of the Pathogenic Bacteria and Their Drug Resistance Pediatric Pneumonia

Objective ：This paper is an attempt to understand the current situation in our hospital pediatric pathogen , and analyze the multi-resistant bacterial resistance and hospital infection and risk factors in order to guide prevention and treatment .Methods ：A retrospective medical records collected from the pediatric pneumonia sputum culture positive clinical and laboratory data ,dated from March 2012 to February 2013 .The results were statistically analyzed .Results：282 pneumonia sputum pathogen developed from the children ;Gram-negative bacilli pathogenic accounted for 220 （78.0% ） ,Gram-positive bacteria 61 （21 .6% ） ,fungal 1 （0 .4% ）;among which Klebsiella pneumoniae accounted for 88 （31 .2% ） ,Escherichia coli 79 （28 .0% ） as the most important pathogens ,both of these pathogens present more visible and multidrug resistance .These two was only 79% sensitive to imipenem 81% ,for Toubao Pai copper /sulbactam was 69% ,74% ,and was mainly sensitive to ofloxacin ,ciprofloxacin ,amikacin ,high as 85% ~96% ,while the com-monly used antibiotics such as ceftazidime ,cefotaxime ,ceftriaxone ,the susceptibility rate was only 38% ~59% ,for Klebsiella pneumoniae and Escherichia coli super broad-spectrum β-lactamases （ESBLs） ,the ratio stood at （43/88 ,41/79）;for ESBLs positive strains were＆gt; 80% resistance to the third generation cephalosporins .Hospital infection and multi-drug resistant risk factors ：age ,presence of underlying disease ,low immunity ,recurrent respiratory infections , the use of 3 or more than 3 kinds of antibiotics ,use of antibiotics ≥14 days .Conclusion：The hospital pediatric pneumo-nia pathogens were mainly opportunistic pathogen ,which mainly included Gram-negative bacilli These bacteria present a higher resistance rate to commonly used penicillin ,cephalosporin ,ceftriaxone ,β-inside lactamase inhibitory ,imipenem and other senior antibiotic .Clinicians should pay close attention to the use and strictly limit the use of antibiotics which may cause high potential resistance .