中山地区儿童急性下呼吸道感染的病原菌分布及耐药性研究

摘要

Objective:To analyze the distribution of pathogens and their drug resistance of children with acute lower respiratory infection .Method:As a research object , 568 children with acute lower respiratory in-fection who treated from August 2011 to December 2012 in Dongfeng hospital of Zhongshan .The specimens in deep phlegm with children were collected by painless sputum suction method .And sent to laboratory for bacterial culture , strain identification and drug sensitive test immediately .Result:A total of 162 pathogens were detected , with a total positive rate of 28.5%.There was 63 gram-positive, accounting for 38.89%;gram-negative bacteria bacteria 96, accounting for 59.26%, fungi strains accounting for 1.85%.Distribution of pathogenic bacteria different in each age group children with acute lower respiratory tract infections , gram-positive bacterium more in 0-4 years old children , gram-negative bacteria distributed in each age group . Gram-negative bacteria were Staphylococcus aureus and Streptococcus pneumoniae .The drug resistance rate of Erythromycin, Penicillin , Clindamycin and Benzene azole sodium were 22.5%-87.50%, and was more sensitive to antibiotics such as Vancomycin and Clindamycin .Gram-negative bacteria were Klebsiella pneu-moniae, Escherichia coli , Pseudomonas aeruginosa ,Sewer enterobacter and Haemophilus influenzae based , and sensitive to Amikacin ,Ciprofloxacin , Bake south imine .The high resistance of antibiotics were Cefazo-lin, Cefuroxime, Piperacillin sodium and Ampicillin.Conclusion:Gram negative bacteria is the main patho-genic bacteria in children with acute lower respiratory infections , Klebsiella pneumoniae , Escherichia coli and Pseudomonas aeruginosa are based .The trend of antibiotic resistance is ncreased .We must to specifica-tion using strengthen the monitoring , as far as possible to rational using the antimicrobial agents base for the results of drug susceptibility .%目的：了解中山地区儿童急性下呼吸道感染的病原菌分布及其耐药性。方法：以中山市东凤医院2011年8月至2012年12月诊治的568名急性下呼吸道感染患儿为研究对象，采用无痛吸痰法采集患儿深部痰标本，并立即送实验室作细菌培养，然后进行菌株鉴定和药物敏感试验。结果：检测出细菌162株，阳性率为28．5％。其中革兰阳性菌63株，占38．89％，革兰阴性菌96株，占59．26％，真菌3株，占1．85％。不同年龄段儿童下呼吸道感染病原菌分布不同，革兰阳性菌多见0-4岁患儿，革兰阴性菌在不同的年龄段均有分布。革兰阳性菌以金黄色葡萄球菌和肺炎链球菌为主，对红霉素、青霉素、克林霉素和苯唑西林钠的耐药性为22．5％-87．50％，较敏感的抗生素为万古霉素和克林霉素。革兰阴性菌以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌和流感嗜血杆菌为主，对阿米卡星、环丙沙星、亚胺培南较为敏感，耐药性高的抗生素为头孢唑啉、头孢呋辛、哌拉西林钠、氨苄西林。结论：革兰阴性菌是儿童急性下呼吸道感染的主要病原菌，以肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌为主，对抗生素的耐药率呈增高趋势，须规范使用和加强监控，尽量根据药敏结果合理使用抗菌药物。