Objective To explore the major pathogens of bacterial pneumonia in children and their drug resistance .Methods Pathogens in nasopharyngeal secretion samples of 1000 children with bacterial pneumonia admitted in hospital were examined ,and drug resistance of isolates was detected by disk diffusion method .Results The main pathogens of bacterial pneumonia in children were Gram-negative bacteria (G - ) , which was found in 214 cases (82 .95％ ) and the majority were Klebsiella pneumoniae (26 .36％ ) and Escherichia coli (24 .42％ ) .There were 29 strains of Gram-positive bacteria (G + ) (11 .24％ ) ,among which Streptococcus pneumoniae (5 .04％ ) and Staphylococcus aureus (4 .26％ ) were most common .In addition ,there were 6 strains of Candida albicans (2 .33％ ) .Bacteriostatic test found that number of antimicrobials whose rate of resistance against ESBL ( - ) Klebsiella pneumoniae , ESBL ( - ) Escherichia coli and Acinetobacter baumanii higher than 50％ was less than that of antimicrobials whose rate of resistance less than 25％ ,and difference had statistical significance (χ2 value was 8 .89 ,7 .03 and 7 .04 , respectively ,all P < 0 .05) .Number of antimicrobials whose rate of resistance against ESBL ( + ) Escherichia coli more than 50％was more than that of antimicrobials whose rate of resistance less than 25％ with statistical difference (χ = 4 .82 ,P < 0 .05) . Number of Klebsiella pneumoniae whose resistance rate higher than 50％ against selected antimicrobials was significantly less than that lower than 25％ ,and the difference was significant (χ2 = 0 .56 ,P < 0 .05) .Number of Staphylococcus aureus whose resistance rate higher than 50％ against selected antimicrobials was significantly less than that lower than 25％ (χ2 = 7 .03 , P < 0 .05) . Conclusion Gram-negative bacteria is the major pathogen in children with pneumonia in the area .Clinical medication should be based on pathogen detection and drug sensitivity test .%目的 探讨本地区引发小儿细菌性肺炎的主要病原菌及其耐药性特征.方法 选取2014年1月1日至2016年12月31日期间入住陕西省渭南市中心医院儿科病房的肺炎患儿1000例,检测细菌性肺炎患儿的鼻咽分泌物样本中病原菌,同时采用纸片扩散法检测分离菌株的耐药性.结果 细菌性肺炎患儿的主要致病菌为革兰氏阴性菌(G-),共214例(82.95％),其中以肺炎克雷伯菌(26.36％)和大肠埃希菌为主(24.42％);革兰氏阳性菌(G+)29株(11.24％),以肺炎链球菌(5.04％)、金黄色葡萄球菌(4.26％)为主,此外有6株(2.33％)白色假丝酵母.抑菌试验发现,超广谱 β-内酰胺酶阴性[ESBL(-)]肺炎克雷伯菌 、ESBL(-)大肠埃希菌及鲍曼不动杆菌耐药率高于50％ 的药物种类数明显少于耐药率低于25％ 的种类数,差异均有统计学意义(χ2=8.89、7.03、7.04,均P<0.05);超广谱 β-内酰胺酶阳性ESBL(+)大肠埃希菌耐药率高于50％ 的药物种类数明显多于耐药率低于25％ 的种类数,差异有统计学意义(χ2=4.82,P<0.05).肺炎链球菌对所选15种抗菌药物中耐药率高于50％ 的药物种类数与低于25％ 的种类数间差异无统计学意义(χ2=0.56,P>0.05);金黄色葡萄球菌对所选抗菌药物中耐药率高于50％ 明显少于低于25％ 的药物种类数,差异具有统计学意义(χ2=7.03,P<0.05).结论 革兰阴性细菌为本地区小儿肺炎的主要病原菌,临床中应依据病原菌检测及药敏试验结果选择用药.
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