目的：了解儿童社区获得性肺炎的病原菌中产超广谱β-内酰胺酶(ESBLs)菌株的检出率、病原菌分布情况及耐药特征。方法收集2012年7月至2013年12月入住本院儿科病房儿童社区获得性肺炎患儿痰标本培养，采用纸片扩散法及双纸片法检测产ESBLs菌株，并对产ESBLs菌株进行药敏试验及进行耐药性分析。结果在1241份社区获得性肺炎患儿痰液标本中共培养出产ESBLs菌株77株，检出率为6.2%，其中肺炎克雷伯菌36株，占46.8%，大肠埃希菌41株，占53.2%。大肠埃希菌及肺炎克雷伯菌对头孢他啶的耐药率分别为26.8%、63.9%，对氨苄西林舒巴坦的耐药率分别为43.9%、80.6%，对哌拉西林他唑巴坦的耐药率分别仅为0、2.8%，而对头孢吡肟的耐药率分别为12.2%、44.4%，对头孢替坦、亚胺培南及美罗培南的耐药率均为0。结论临床上对于产ESBLs菌株感染的儿童社区获得性肺炎治疗应根据临床情况和药敏试验结果，选用β-内酰胺类/β-内酰胺酶抑制剂复方制剂、头孢西丁、头孢替坦等头霉素类，或亚胺培南等碳青霉烯类抗生素进行治疗。%Objective To investigate the detection rate, the distribution and drug resistance characteristics of extended-spectrumβ-lactamase (ESBLs)-producing strains isolated from pathogens of community-acquired pneu-monia in children. Methods Sputum specimens were collected from the children with community-acquired pneu-monia in Pediatric Wards in our hospital from Jul. 2012 to Dec. 2013. Disk diffusion and double-disk were used to detect ESBLs-producing strains, and the drug sensitivity and resistance of the strains were tested. Results From the 1 241 collected sputum specimens of acquired pneumonia, a total of 77 ESBLs-producing strains were obtained (with the detection rate of 6.2%), including 36 strains of Klebsiella pneumonia (accounting for 46.8%) and 41 strains of Escherichia coli (53.2%). The resistance rates of Escherichia coli and Klebsiella pneumonia to ceftazidime were 43.9%and 80.6%, 0%and 2.8%to piperacillin tazobactam, 12.2%and 44.4%to cefepime, respectively. Their resis-tance rates to cefotetan, imipenem and meropenem were all 0. Conclusion According to the clinical conditions and susceptibility test results, β-lactam/β-lactamase inhibitor compound, cefoxitin, cefotetan and other cephamy-cins or carbapenems such as imipenem are the effective antibiotics for community-acquired pneumonia in children caused by ESBLs-producing strains.
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