重症肺炎患儿细菌学病原谱及其耐药情况分析

摘要

目的：分析重症肺炎患儿细菌学病原谱及其耐药情况，为合理使用抗菌药物提供科学依据。方法选取2010年8月—2014年8月深圳市宝安区妇幼保健院儿科重症监护病房（PICU）收治的重症肺炎患儿604例，在抗感染治疗前采集痰液、肺泡灌洗液及血液行细菌培养及药敏试验，分析其细菌学病原谱及主要致病菌对常用抗菌药物的耐药情况。结果604例重症肺炎患儿共检出致病菌442株，其中革兰阴性菌339株（76.7%）、革兰阳性菌136株（23.3%）。革兰阳性菌中最常见的是金黄色葡萄球菌，革兰阴性菌中最常见的是肺炎克雷伯菌。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌及阴沟肠杆菌对氨苄西林和头孢唑林的耐药率较高，均在90.0%以上；肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌对美洛培南、亚胺培南、环丙沙星及左氧氟沙星耐药率低，均在15.0%以下。金黄色葡萄球菌对青霉素、复方磺胺甲噁唑、红霉素、四环素的耐药率较高，均在75.0%以上；肺炎链球菌对青霉素、复方磺胺甲噁唑、红霉素、四环素的耐药率较高，均在70.0%以上；金黄色葡萄球菌和肺炎链球菌对万古霉素和利奈唑胺均无耐药。结论重症肺炎患儿细菌感染以革兰阴性菌为主，且对多种抗菌药物耐药，临床应根据小儿重症肺炎细菌学病原谱及其耐药情况选择合理的抗菌药物进行治疗。%Objective To analyze the bacteriological pathogenic spectrum of children with severe pneumonia and its drug resistance,to provide references for rational use of antibacterial agents. Methods From August 2010 to August 2014 in the Pediatric Intensive Care Unit,Maternal and Child Care Service center of Baoan District,Shenzhen,a total of 604 children with severe pneumonia were selected,their sputum,alveoli lavage fluid and blood were collect to carry out bacterial culture and drug sensitivity test,the bacteriological pathogenic spectrum and drug resistance of major pathogens to common antibacterial agents were analyzed. Results A total of 442 strains of pathogenic bacteria was cultured out,including 339 strains of Gram -negative bacteria(76. 7% ) and 136 strains of Gram - positive bacteria(23. 3% ),thereinto Staphylococcus aureus was the most common Gram - positive bacteria,Klebsiella pneumoniae was the most common Gram - negative bacteria. Drug sensitivity test showed that,the drug resistant rate to ampicillin and cephazolin of Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,Acinetobacter baumannii and Enterobacter cloacae were all over 90. 0% ;the drug resistant rate to meropenem, imipenem,ciprofloxacin and levofloxacin of Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa were all below 15. 0% ;the drug resistant rate to penicillin,compound sulfamethoxazole,erythromycin and acheomycin of Staphylococcus aureus were all over 75. 0% ;the drug resistant rate to penicillin,compound sulfamethoxazole,erythromycin and acheomycin of Streptococcus pneumoniae were all over 70. 0% ;no drug resistant strains of Staphylococcus aureus or Streptococcus pneumoniae was found to vancomycin or linezolid. Conclusion Gram - negative bacteria is the major pathogens of children with severe pneumonia,and its drug resistant rate is high,clinician should selected rational antibacterial agents based on bacteriological pathogenic spectrum and its drug resistance.