目的 了解该院2013-2016年儿童呼吸道感染病原菌分布及药敏变化情况,为临床合理使用抗菌药物提供参考依据.方法 收集该院2013-2016年儿童呼吸道标本,按照标准操作规程进行培养及鉴定,采用K-B法进行药敏试验(金黄色葡萄球菌除外,仪器法),依据美国临床和实验室标准化协会2016年版标准判读结果 ,使用WHONET 5.6进行统计学分析.结果剔除来自同一患者的重复菌株,10220例标本分离出病原菌2136株,阳性率为20.90％,其中革兰阴性杆菌1247株(58.38％),革兰阳性球菌871株(40.78％),真菌18株(0.84％).最常见的病原菌依次为肺炎链球菌(598株,28.00％)、流感嗜血杆菌(244株,11.42％)、金黄色葡萄球菌(229株,10.72％)、铜绿假单胞菌(193株,9.04％),真菌感染主要是白色假丝酵母菌(11株,0.51％).新生儿时期,大肠埃希菌和肺炎克雷伯菌检出率最高,随着儿童年龄的增长,肺炎链球菌和流感嗜血杆菌检出率逐年升高.2013-2016年流感嗜血杆菌的检出率逐年增高,大肠埃希菌的检出率逐年降低.肺炎链球菌和金黄色葡萄球菌对万古霉素和利奈唑胺最敏感,金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌的阳性率为22.71％.流感嗜血杆菌β-内酰胺酶阳性率为57.79％.铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为12.40％ 和11.60％.大肠埃希菌和肺炎克雷伯菌对碳青霉烯类较敏感,超广谱β内酰胺酶阳性率分别为54.69％ 和42.86％.结论 该院儿童呼吸道感染病原菌分布和耐药变化有其不同特点,临床应重视病原菌的检测及药敏试验,合理使用抗菌药物,减少耐药菌株的产生.%Objective To investigate the distribution and the change of drug sensitivity of pathogenic bacte-ria in children′s respiratory tract infection during 2013 to 2016 ,and to provide reference for clinical treatment . Methods Specimens of children′s respiratory tract from the hospital during 2013 to 2016 were collected .Cul-tivation and identification were implemented according to standard operating procedure ,the antimicrobial sus-ceptibility was tested with K-B method (except Staphylococcus aureus with instrument method ) ,Results were interpreted with the CLSI 2016 Standard .All the data were analyzed with WHONET 5 .6 software . Results When the repeated strains from the same patient were screened out ,2136 strains of pathogenic bac-teria were isolated from 10220 specimens ,the positive rate was 20 .90％ ,of which 1247 were gram-negative bacilli (58 .38％ ) ,871 strains were gram-positive coccus (40 .78％ ) and 18 were fungi (0 .84％ ) .The most common pathogenic bacteria were Streptococcus pneumoniae (598 strains ,28 .00％ ) ,Haemophilus influenzae (244 strains ,11 .42％ ) ,Staphylococcus aureus (229 strains ,10 .72％ ) ,Pseudomonas aeruginosa (193 strains , 9 .04％ ) ,and Candida albicans (11 strains ,0 .51％ ) .In neonatal period ,the detection rate of Escherichia coli and Klebsiella pneumoniae was the highest .With the increase of age ,the detection rate of Streptococcus pneu-moniae and Haemophilus influenzae increased year by year .During 2013 to 2016 ,the detection rate of Hae-mophilus influenzae increased year by year ,and the detection rate of Escherichia coli decreased year by year . Streptococcus pneumoniae and Staphylococcus aureus were most sensitive to vancomycin and linezolid ,and the positive rate of methicillin resistant Staphylococcus aureus in Staphylococcus aureus was 22 .71％ .The positive rate of Haemophilus influenzae beta lactamase was 57 .79％ .The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 12 .40％ and 11 .60％ respectively .Escherichia coli and Klebsiella pneumon-iae were more sensitive to carbapenems ,and the positive rates of extended spectrum beta lactamases were 54 .69％ and 42 .86％ respectively .Conclusion T he distribution of pathogenic bacteria and drug resistant changes of child respiratory infection had respective characteristics in the hospital .The detection of pathogenic bacteria and drug sensitivity test should be paid attention to ,and antibiotics should be used rationally to reduce the production of drug resistant strains .
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