目的 分析2014至2016年湖南省岳阳县人民医院住院患儿送检痰样本的致病菌构成及耐药情况,为本地区儿童肺部感染性疾病的临床诊疗与疾病控制决策提供科学依据.方法 查阅2014至2016年来本院诊疗的4 759例儿科住院患者入院后第1次痰标本细菌培养与药敏试验结果资料,对各年度检出的致病菌种类、分离率、耐药率及年间变化趋势进行回顾性分析.结果 在送检的4 759份痰样本中,分离培养出1 414株致病菌,包括金黄色葡萄球菌、肺炎链球菌、大肠埃希氏菌、肺炎克雷伯菌、流感嗜血杆菌、卡他莫拉菌、产酸克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、产气肠杆菌等10个细菌菌种,总分离率为29.71％,2014年、2015年、2016年的年度分离率分别为32.38％、30.42％、24.75％,呈逐年下降趋势.3年耐药率均超过50％的细菌-药物对有:金黄色葡萄球菌-青霉素(99.32％-100.00％)、大肠埃希氏菌-氨苄西林(80.90％-89.53％)、大肠埃希氏菌-头孢唑啉(60.65％-73.07％)、肺炎克雷伯菌-头孢唑啉(51.04％-55.10％)、流感嗜血杆菌-氨苄西林/舒巴坦(52.17％-56.52％)、流感嗜血杆菌-复方新诺明(59.70％-78.26％)、流感嗜血杆菌-氨苄西林(53.73％-65.22％);3年间耐药率呈现逐年上升趋势的细菌-药物对有:金黄色葡萄球菌-青霉素、肺炎链球菌-红霉素、肺炎链球菌-头孢曲松、大肠埃希氏菌-氨苄西林/舒巴坦、大肠埃希氏菌-氨苄西林、肺炎克雷伯菌-左氧氟沙星、肺炎克雷伯菌-哌拉西林/他唑巴坦、卡他莫拉菌-阿奇霉素.结论 本地区肺部疾病儿童患者痰液中病原菌种类多、耐药率高,应加强细菌学检测并强化抗生素的合理应用.%Objective To provide scientific basis for the clinical diagnosis,treatment,prevention,and control of lung infectious diseases in children in the region by analyzing the composition and drug resistance of pathogens isolated from the sputum of pediatric inpatients hospitalized into our hospital from 2014 to 2016.Methods The data of identification and antimicrobial susceptibility test of bacteria isolated from the first sputum in 4 759 pediatric inpatients from 2014 to 2016 were reviewed.The species of pathogens,isolation rate,resistance rate and trend during the three years were analyzed retrospectively.Results One thousand four hundreds fifteen strains of pathogens were isolated and identified as following 10 species:Staphylococcus aureus,Streptococcus pneumoniae,Escherichia coli,Klebsiella pneumoniae,Haemophilus influenzae,Moraxella catarrhalis,Klebsiella oxytoca,Pseudomonas aeruginosa,Acinetobacter baumannii,and Enterobacter aerogenes.The total isolation rate of pathogens was 29.71％ during the three years.The annual isolation rates were 32.38％,30.42％,and 24.75％ in 2014,2015,and 2016,showing a downward trend year by year.As to drug resistance of these pathogens to given antibiotics,the combination of pathogen and antibiotic whose drug-resistant rate over 50％ in all three years were Staphylococcus aureus-Penicillin (99.32％-100.00％),Escherichia coli-Ampicillin (80.90％-89.53％),Escherichia coli-Cephazolin (60.65％-73.07％),Klebsiella pneumoniae-Cephazolin (51.04％-55.10％),Haemophilus influenzae-Ampicillin/sulbactam (52.17％-56.52％),Haemophilus influenzae-Trimesulf (59.70％-78.26％),and Haemophilus influenzae-Ampicillin (53.73％-65.22％).And the combination of pathogen and antibiotic,of which the resistance rate showed a rising trend in all three years,were Staphylococcus aureus-Penicillin,Streptococcus pneumoniae-Erythromycin,Streptococcus pneumoniae-Eeftriaxone,Escherichia coli-Ampicillin/sulbactam,Escherichia coli-Ampicillin,Klebsiella pneumoniae-Levofloxacin,Klebsiella pneumoniae-Piperacillin/Tazobactam,and Moraxella catarrhalis-Azithromycin.Conclusion Based on the fact of various kinds of species of pathogens and high drug-resistance rate,it is essential to attach importance to the bacteriological test and to improve the rational application of antibiotics.
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