摘要
目的了解儿童下呼吸道感染的病原学特点及其对抗菌药物的耐药性,为临床诊疗提供依据。方法选择湖南省儿童医院2014年1月至2015年12月因下呼吸道感染住院的患儿,常规进行深部痰培养,用VITEK2 Compact全自动微生物分析仪进行鉴定和药敏试验。结果 34 866份诊断为下呼吸道感染患儿的合格痰标本,共分离出115种合计12 669株病原菌,阳性率为36.3%。主要检出菌为:肺炎克雷伯菌3 102株(24.5%)、大肠埃希菌1 717株(13.6%)、金黄色葡萄球菌1 301株(10.3%)、肺炎链球菌1 180株(9.3%)等。病原菌中,革兰阳性(G^+)菌3 743株(29.5%),革兰阴性(G^-)菌8 862株(70.0%),真菌64株(0.5%)。部份菌种在不同年龄段和不同季节检出率有所不同,患儿痰培养阳性率:0~1岁为42.8%(6 113/14 295),>1~3岁为33.3%(3 710/11 127),>3~6岁为31.2%(1 959/6 275),>6~14岁为28.0%(887/3 169),各年龄组检出率比较差异均有统计学意义(均P<0.001)。卡他莫拉菌冬春季感染率高于夏秋季[0.99%(344/34 866)比0.56%(196/34 866),P<0.001];流感嗜血杆菌春夏季感染率高于秋冬季[0.46%(160/34 866)比0.2%(72/34 866),P<0.001];鲍曼不动杆菌夏秋季感染率高于春冬季[2.1%(741/34 866)比0.9%(309/34 866),P<0.001];而铜绿假单胞菌秋季感染率最高[0.5%(174/34 866),P<0.001];其他细菌的四季感染率比较差异均无统计学意义(均P>0.05)。肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌等高度耐药G^-菌(对氨苄西林的耐药率分别为:100.0%、83.7%、89.1%、100.0%,对头孢唑啉的耐药率分别为:74.4%、74.3%、87.3%、100.0%,对头孢曲松的耐药率分别为:71.1%、71.1%、74.4%、76.5%,对亚胺培南、哌啦西林/他唑巴坦、左旋氧氟沙星较敏感);而金黄色葡球菌、肺炎链球菌等G+菌对青霉素和氨苄西林等高度耐药(对青霉素的耐药率分别为:89.1%、66.8%,对氨苄西林耐药率分别为:81.0%、59.4%),未发现耐万古霉素的金黄色葡萄球菌。结论我院患儿下呼吸道感染发病率较高,耐药形势严峻,应加强呼吸道病原学检测,减少耐药菌株的产生。
Objective To investigate pathogenic characteristics and drug resistance of children with lower respiratory tract infection, so as to provide epidemiology data for clinical treatment. Methods The conventional deep sputum culture was performed and the identification and drug sensitivity test were carried out by automatic microbial analyzer vitek2 for children with lower respiratory tract infection hospitalized in Hunan Children＇s Hospital from January 2014 to December 2015. Results From 34 866 eligible sputum samples, 12 669 strains of pathogenic bacterial were isolated, the total number of pathogenic bacteria was 115, the positive rate was 36.3%. Klebsiella pneumoniae 3 102 strains （24.5%）, Escherichia coli 1 717 strains （13.6%）, Staphylococcus aureus 1 301 strains （10.3%）, Streptococcus pneumoniae 1 180 strains （9.3%） were the main pathogens. There were 3 743 Gram-positive bacteria （29.5%）, Gram-negative bacteria 8 862 strains （70.0%）, Fungal 64 strains （0.5%） among all pathogens. The detection rate was varied in different ages and seasons in some certain bacterial. The positive rates of cultivate culture were 0-1 years old： 42.8% （6 113/ 14295）, 〉 1-3 years old： 33.3% （37t0/II 127）, 〉 3-6 years old： 31.2% （1 959/6 275）, 〉 6-14 years old ： 28.0% （ 887/3 169 ）, respectively, there were statistical significance in differences of detection rates of each age group （all P 〈 0.001）. The infection rates of Moraxella catarrhalis in winter and spring were higher than those in summer and autumn [0.99% （344/34 866） vs. 0.56% （196/34 866）, the difference were statistically significant P 〈 0.001]. The infection rates of Haemophilus influenzae in spring and summer were higher than those in autumn and winter [0.46% （160/34 866） vs. 0.2% （72/34 866）, P 〈 0.001] . The infection rate of Pseudomonas aeruginosa was highest in autumn [0.5% （174/34 866）, P 〈 0.001] . There was no significant difference in the infection rate of other bacteria （P 〉 0.05）. Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa were highly resistant Gram-negative bacteria （the resistant rates to ampicillin were 100.0%, 83.7%, 89.1%, 100.0% respectively, the resistant rates to cefazolin were 74.4%, 74.3%, 87.3%, 100.0% respectively, the resistant rates to ceftriaxone were 71.1%, 71.1%, 74.4%, 76.5% respectively, but susceptible to imipenem, piperazine, amoxicillin/tazobactam levofloxacin ）; Gram-positive bacteria including Staphylococcus aureus, Streptococcus pneumoniae were highly resistant to penicillin and ampicillin （the resistant rates to penicillin were 89.1%, 66.8% respectively, the resistant rates to ampicillin were 81%, 59.4% respectively ）, Staphylococcus aureus resistant to vancomycin was no found in the study. Conclusions The morbidity of lower respiratory tract infection was high in children in our hospital, and the drug resistance was fairly severe. We should pay more attention to the monitoring of pathogenic bacteria susceptable to lower respiratory tract so as to reduce the drug-resistant strains.
作者
郭宽鹏
李先斌
宋春荣
刘健龙
康艳
张林
Guo Kuanpeng Li Xianbin Song Chunrong Liu Jianlong Kang Yan Zhang Lin.(Department of Clinical Laboratory, Hunan Chilidren＇s Hospital, Changsha 41007, Hunan, China)
出处
《实用检验医师杂志》
2017年第1期8-12,共5页
Chinese Journal of Clinical Pathologist
关键词
儿童
下呼吸道感染
病原菌
耐药性
Children
Lower respiratory tract infection
Pathogens
Drug resistance
