小儿细菌性肺炎2382例病原菌分布及耐药性分析

目的：了解本地区小儿细菌性肺炎病原菌分布及耐药情况，为临床经验性治疗提供参考。方法：选取2010年1月1日至2012年12月31日我院儿科二病区2382例确诊为细菌性肺炎患儿的痰培养标本，分析病原菌的分布及耐药情况。结果：小儿细菌性肺炎痰培养标本检出病原菌571株，以革兰阴性菌为主，共477株，占83．54％，其中肺炎克雷伯菌占26．44％，大肠埃希菌占25．22％，鲍曼不动杆菌占10．86％；革兰阳性菌共64株，占11．21％，其中金黄色葡萄球菌7．71％。检出的各种病原菌对阿米卡星、亚胺培南、哌拉西林／他唑巴坦均较敏感，除鲍曼不动杆菌对关罗培南耐药外，其他病原菌对其均敏感；金黄色葡萄球菌对左氧氟沙星、呋喃妥因、利福平、头孢西丁、利奈唑胺、莫西沙星、万古霉素、喹奴普汀或迭福普汀均100％敏感，肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、阴沟肠杆菌、铜绿假单胞菌对氨苄西林、头孢唑林的耐药性较高；铜绿假单胞菌对氨苄西林、氨苄西林／舒巴坦、复方磺胺甲嚼唑、头孢曲松、头孢替坦、呋喃妥因100％耐药，鲍曼不动杆菌对氨苄西林、关罗培南、头孢替坦、头孢唑林、呋喃妥因100％耐药。结论：不同地区儿童细菌性肺炎致病菌及其药物敏感性可能不同，临床应根据所在地区的病原菌流行情况及其耐药规律制定最佳的治疗方案，合理应用抗菌药物，避免或减少细菌耐药性的产生。

Pathogen Distribution and Antibiotic Resistance of Infantile Bacterial Pneumonia of 2382 cases

Objective： To investigate the pathogen distribution and antibiotic resistance of bacterial pneumonia in the local infected children, in order to provide reference for clinical empirical therapy. Methods： From January 1st, 2010 to December 31st, 2012, the distribution of pathogens and drug resistance of 2,382 cases with bacterial pneumonia were analyzed. Results： Children with bacterial pneumonia were mainly infected by Gram-negative bacteria （ a total of 477 strains, accounting for 83.54% , Klebsiella pneumoniae 26.44% , Escherichia coli 25.22% and Acinetobacter baumannii 10.86% ）. Gram-positive bacteria were 64 strains, accounting for 11.21% ,of which 7.71% were Staphylococcus aureus. Various pathogens were sensitive to Amikacin, imipenem, piperacillin and sulbactam. They were all sensitive to meropenem except Acinetobacter baumannii. The sensitivity rates of Staphylococcus aureus to levofloxacin, macrodantin, rifampicin, cefoxitin, linezolid, moxifloxacin, vancomycin and ouinupristin-dalfoprisdn were 100% ; but the resistance rates to Ampicillin, cefazolin against Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Enterobacter cloacae and Pseudomonas aeruginosa were 100%. Pseudomonas aeruginosa were resistant to ampicillin, ampiciUin-salbactam, compound sulfamethoxazole, ceftriaxone, cefotetan and nitrofurantoin. Acinetobacter baumannii were resistant to ampicillin, meropenem cefotetan, cefazolin and nitrofurantoin. Conclusions： The popular strains and their drug sensitivity of children＇ bacterial pneumonia may be different in various regions. We must pay attention to these situations and take more effective measures.