摘要
目的总结宝鸡市区小儿急性下呼吸道感染(ALRI)细菌病原谱的构成和细菌药敏情况。方法收集2010-08/2011-07宝鸡市三区五大医院儿科住院的急性下呼吸道感染患儿6234例的痰细菌培养鉴定和药物敏感试验结果进行汇总分析。结果 (1)6234例送检标本中,1827例份结果阳性,阳性率29.31%。共培养出致病菌1882株23种,检出前5位致病菌分别为大肠埃希菌(20.72%)、肺炎克雷伯菌(17.48%)、肺炎链球菌(16.84%)、铜绿假单胞菌(6.59%)、金黄色葡萄球菌(6.32%)。(2)宝鸡市区AL-RI致病菌66.05%是G-菌,其中绝大多数是肠杆菌科细菌占86.56%,且大肠埃希菌、肺炎克雷伯菌高居前2位占57.84%;而G+球菌共占29.05%;真菌位居第7位。(3)大肠埃希菌、肺炎克雷伯菌,对阿莫西林/克拉维酸、替卡西林/棒酸、头孢西丁、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦均高度敏感,可作为经验治疗首选的抗菌药物。所有G-杆菌对亚胺培南均无耐药。铜绿假单胞菌在本地区对头孢他啶高度敏感。肺炎链球菌对青霉素耐药率为70.57%,对一至四代头孢菌素、阿莫西林/克拉维酸等均高度敏感。本地区儿童下呼吸道痰葡萄球菌检出者,主要是金黄色葡萄球菌和凝固酶阴性葡萄球菌(CNS),对苯唑青霉素耐药率依次为92.69%、82.69%,在本地区链球菌属导致的儿童细菌性ALRI仅占到3.03%,对青霉素类抗生素高度敏感,仍是首选抗生素。(4)作为导致儿童ALRI占主要病原的肠杆菌科细菌耐药情况严重,条件致病菌、机会致病菌感染率有增高趋势。结论宝鸡市区儿童ALRI细菌病原谱复杂,有其明确的地域性和时代性特点。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌这4类细菌是宝鸡市区0～14岁儿童各年龄组ALRI的常见致病菌;致病菌以革兰阴性肠杆菌为主,各年龄组又各有其特点;对抗菌药物敏感性也有明显的特点,耐药问题也很严峻。
Objective To summarize spectrum of bacterial pathogens and bacteria-sensitive drugs of Baoji children with acute lower respiratory infections （ALRI）. Methods From 2010-08 to 2011-07 in three domain District of Baoji City, the children from five hospital pediatric inpatient department with acute lower respiratory tract infection made,a retrospective pooled analysis in 6 234 cases about sputum culture identifi- cation and drug susceptibility test results. Results （1）Of 6 234 cases of censorship specimens, 1827 cases were with positive result, the positive rate being 29.31%. The 1 882 co-culture pathogens were divided into 23 kinds and the first 5 pathogens were Escherichia coli（20.72 %）,Klebsiella pneumoniae（17.48%）,Strep- tococcus pneumoniae（16.84 %）, Pseudomonas aeruginosa （ 6.59 % ）, Staphylococcus aureus （6.32 % ）. （2） A- bout 66. 05 % ALR1 pathogens were G- bacteria, the vast majority of Enterobacteriaceae accounted for 86.56 %, and Escherichia eoli, Klebsiella pneumoniae highest in the first two accounted for 57.84 % ;G＋ cocci accounted for 29.05%;fungi ranked the seven. （3）Escheriehia coli and Klebsiella pneumoniae were highly sensitive to Amoxieillin/Clavulanie acid,Tiearcillin/Clavulanie acid,Cefoxitin,Cefoperazone/Sulbaetam,Pip-eracillin/Cilostazol Tazobactam, and could be used as an empiric antimicrobial treatment. All G- bacteria had no resistance to Imipenem. Pseudomonas aeruginosa in the region was highly sensitive to Ceftazidime. Resist- ance rate of streptococcus pneumoniae to penicillin was 70. 57%, highly sensitive to the one to four-genera- tion cephalosporins and amoxiciliin/Clavulanic acid. Children in the region with lower respiratory tract spu- tum staphylococcus mainly had Staphylococcus aureus and coagulase-negative staphylococci（CNS）,with ox- acillin resistance rate being 92.69 % and 82.69% %Streptococcus in the region leading to bacterial ALR1 in children accounted for only 3.03% , highly sensitive to the antibiotics, so penicillin was still the preferred antibiotic. （4）Enterobacteriaceae as ALRI predominant pathogen in children had serious resistance,and op- portunistic pathogen and opportunistic infection rates were likely to increase. Conclusions In Baoji children ALRI bacterial pathogen spectrum has clear region and time features. Klebsiella pneumoniae, Escherichia co- li, Pseudomonas aeruginosa,Streptococcus pneumoniae are 4 common p%thogens in 0% 14 year-old children in Baoji; pathogenic bacteria are mainly Gram-negative Enterobacteriaceae, and each age group has its own char- acteristics; antimicrobial susceptibility is obvious,and drug resistance problem is very grim.
出处
《中国中西医结合儿科学》
2012年第5期407-414,共8页
Chinese Pediatrics of Integrated Traditional and Western Medicine
关键词
下呼吸道感染
细菌
病原谱
药物敏感性
多中心研究
儿童
lower respiratory infections
bacteria
pathogen spectrum
drug sensitivity
multi-center
children
