570例儿童社区获得性肺炎致病菌及耐药情况的分析

摘要

Objective The objective of this paper is to investigate the characteristics of pathogenic bacteria and drug resistance in children with community-acquired pneumonia and to provide the evidence for rational use of antimicrobial in clinical diagnosis. Method 570 sputum samples of children with community-acquired pneumonia were collected and cultured for aerobic bacteria and antibiotic susceptibility testing were followed. Results 224 bacterial strains are inspected from 570 children with community-acquired pneumonia. The detection rate is 39.3%, among which gram-positive is 28.2% and gram-negative is 71.8%. The main pathogenic bacteria were klebasiella pneumoniae(47 strains), escherichia coli(25 strains), klebsiella oxytoca(18 strains), staphylococcus epidermidis(18 strains), staphylococcus intermedius(14 strains)and staphylococcus aureus (12 strains). The detection rates of extended spctrum beta-lactamases producing salmonella(ESBLs)is 59.6% in klebasiella pneumoniae(28/47), 64% in Escherichia coli(16/25)and 55.6% in Klebsiella oxytoca (10/18). The methicillin-resistant staphylococcus aureus(MRSA)is 0%(0/12)and the methicillin resistant coagulase negative staphylococcus(MRCON)is 52.9%(27/51). The top three gram negative bacteria are highly sensitive to piperacillin tazobactam, cefoperazone/sulbactam and amikacin.Their drug resistance rate to ampicillin is 100%, to cephalosporin(except cefoxitin)and aztreonam are almost more than 50%. Staphylococcus aureus are drug-resistant to penicillin.The drug resistance of staphylococcus epidermidis is signiifcantly higher than that of staphylococcus aureus. Conclusions The pathogenic bacteria in children with community-acquired pneumonia is mainly gram negative bacteria. The main pathogenic bacteria have strong drug resistance. It is beneifcial for the guide of rational drug use in clinical diagnosis and the management of multiple drug-resistant bacteria to strengthen the monitoring and analysis of bacteria.%目的：了解儿童社区获得性肺炎常见病原菌分布及耐药情况，为临床合理应用抗菌药物提供依据。方法对570例儿童社区获得性肺炎的痰标本进行培养并做药敏试验。结果570例标本共检出致病菌224株，总阳性率为39.3%，其中革兰阳性菌、革兰阴性菌分别占28.2%、71.8%。主要致病菌依次为肺炎克雷伯菌47株、大肠埃希菌25株、产酸克雷伯菌18株、表皮葡萄球菌18株、中间葡萄球菌14株、金黄色葡萄球菌12株。肺炎克雷伯菌和大肠埃希菌、产酸克雷伯菌产超广谱β-内酰胺酶（ESBLs）阳性率分别为：59.6%（28/47）、64%（16/25）、55.6%（10/18）。耐甲氧西林金黄色葡萄球菌MRSA为0%，耐甲氧西林凝固酶阴性葡萄球菌株（MRCON）52.9%（27/51）。前3位革兰阴性菌对哌拉西林他唑巴坦、头孢哌酮/舒巴坦、阿米卡星敏感度高，对氨苄西林耐药率达100%；对头孢类（除头孢西丁外）及氨曲南耐药率几乎均超过50%。金黄色葡萄球菌对青霉素均耐药。表皮葡萄球菌的耐药性明显高于金黄色葡萄球菌。结论儿童社区获得性肺炎致病菌以革兰阴性菌为主，主要病原菌有较强耐药性。加强细菌监测分析，有利于指导临床合理用药及对多重耐药菌的管理。