2005-2010年小儿下呼吸道感染病原菌分布及耐药性分析

目的 了解义乌市中心医院小儿下呼吸道感染的病原菌分布及耐药性.方法 2005年1月—2010年12月临床住院患儿下呼吸道分泌物进行细菌培养和药敏试验.结果 从下呼吸道感染的患儿中共分离出病原菌780株(儿童523株,新生儿257株)；以革兰阴性菌为主,共429株,占55.00％,革兰阳性菌237株,占30.38％,真菌114株,占14.62％；其中新生儿真菌分离率为21.01％,明显高于儿童的11.47％(x2=12.57,P＜0.001)；肺炎克雷伯菌对环丙沙星、亚胺培南全敏感；较敏感的是头孢哌酮/舒巴坦等β-内酰胺酶抑制剂复合物；新生儿肺炎克雷伯菌株对大部分抗菌药物的耐药率明显高于儿童株(P＜0.05),肺炎链球菌对万古霉素全部敏感,对多种抗菌药物有不同程度的耐药.结论 小儿下呼吸道感染的病原菌以革兰阴性菌为主,新生儿下呼吸道感染的病原学的分布及耐药性与儿童有明显不同,临床医师应密切关注,合理选择抗菌药物.

Distribution and drug resistance of pathogens causing lower respiratory tract infections in children from 2005 to 2010

OBJECTIVE To explore the distribution and drug resistance of pathogens causing lower respiratory tract infections in children admitted in Yiwu Central Hospital.METHODS The bacterial culture and drug susceptibility testing were performed for pathogens isolated from secretions of children with lower respiratory tract infections from Jan 2005 to Dec 2010.RESULTS A total of 780 strains of pathogens isolated(including 523 strains from children and 257 strains from newborns infants);the isolation rate of gram-negative bacteria was the highest(429 strains,55.00%),followed by gram-positive bacteria(237 strains) and fungi(114 strains) which were 30.38% and 14.62%,respectively;the isolation rate of fungi from newborn infants was 21.01%,significantly higher than 11.47% from children(χ2=12.57,P<0.001);Klebsiella pneumoniae isolates were the most susceptible to imipenem and ciprofloxacin,followed by cefoperazone/sulbactam and other β-lactamase inhibitor complex,the antimicrobial resistance rate of Klebsiella pneumoniae isolates from newborns infants was significantly higher than pediatric patients(P<0.05);all Streptococcus pneumoniae isolates were susceptible to vancomycin,but resistance to many antibiotics at varied degrees.CONCLUSION Gram-negative bacteria are the predominate pathogens causing lower respiratory tract infections in children;the species and drug resistance of pathogens causing lower respiratory tract infections of newborn infants significantly differ from those of pediatric patients,to which clinician should pay close attention and choose antibiotics reasonably.