摘要
目的了解2016年至2018年我国下呼吸道感染患儿的肺泡灌洗液病原菌分布及其对抗菌药物的耐药情况。方法采集2016年1月至2018年12月10家三级医院收治的年龄<18岁的下呼吸道感染患儿的肺泡灌洗液标本,培养分离获得病原菌。采用纸片扩散法或最低抑菌浓度法对分离菌株进行药物敏感试验,分析病原菌的分布情况,以及菌株来源科室情况。统计学分析采用χ^(2)检验。结果共收集肺泡灌洗液阳性分离菌株1271株,其中革兰阴性菌606株(47.7%),革兰阳性菌628株(49.4%),真菌37株(2.9%)。常见的病原菌依次为肺炎链球菌(466株,36.7%)、鲍曼不动杆菌(214株,16.8%)、金黄色葡萄球菌(162株,12.7%)、肺炎克雷伯菌(105株,8.3%)、流感嗜血杆菌(94株,7.4%)、铜绿假单胞菌(79株,6.2%)、洋葱伯克霍尔德菌(67株,5.3%)和大肠埃希菌(47株,3.7%)。重症监护病房(intensive care unit,ICU)来源分离菌以革兰阴性菌为主(80.1%,428/534),其中鲍曼不动杆菌最常见(37.3%,199/534);非ICU来源菌株以革兰阳性菌为主(70.8%,522/737)。ICU和非ICU来源菌株中,耐甲氧西林金黄色葡萄球菌检出率分别为45.1%(23/51)和43.2%(48/111),耐青霉素肺炎链球菌检出率分别为10.9%(6/55)和18.5%(76/411),耐碳青霉烯类肺炎克雷伯菌检出率分别为57.3%(43/75)和33.3%(10/30)。ICU来源耐碳青霉烯类铜绿假单胞菌检出率高于非ICU来源菌株[49.1%(27/55)比25.0%(6/24)],差异有统计学意义(χ^(2)=3.98,P=0.046)。耐碳青霉烯类大肠埃希菌检出率为17.0%(8/47),耐碳青霉烯类鲍曼不动杆菌检出率为76.6%(164/214)。78株流感嗜血杆菌分离自非ICU患儿标本,流感嗜血杆菌对氨苄西林的耐药率为57.4%(54/94);洋葱伯克霍尔德菌均分离自ICU患儿标本,其对哌拉西林他唑巴坦、左氧氟沙星、环丙沙星、复方磺胺甲噁唑的耐药率分别为13.4%(9/67)、3.0%(2/67)、0(0/67)和9.0%(6/67)。结论肺炎链球菌依然是我国儿童下呼吸道感染最常见的致病菌,革兰阴性杆菌是ICU下呼吸道感染患儿主要的致病菌。耐甲氧西林金黄色葡萄球菌、耐青霉素肺炎链球菌、耐碳青霉烯类革兰阴性杆菌检出率均较高,流感嗜血杆菌对氨苄西林耐药率较高。临床经验治疗中应结合临床背景选择合适的初始抗菌药物。
Objective To analyze the distribution and antimicrobial resistance pattern of bacteria isolated from alveolar lavage fluid in pediatric patients with lower respiratory tract infection from 2016 to 2018.Methods The alveolar lavage fluid of pediatric patients aged<18 years old with lower respiratory tract infection in ten hospitals from January 2016 to December 2018 were collected,and the pathogenic bacteria were cultured and isolated.The paper diffusion method or minimum inhibitory concentration method was used to conduct drug susceptibility tests for the isolated strains.The distribution of pathogenic bacteria and the source department of the strains were analyzed.Chi-sqare test was used for statistical analysis.Results Of 1271 isolates,606 strains(47.7%)were gram-negative bacteria,628 strains(49.4%)were gram-positive bacteria,and 37 strains(2.9%)were fungi.The common pathogens were Streptococcus pneumoniae(36.7%,466/1271),Acinetobacter baumannii(16.8%,214/1271),Staphylococcus aureus(12.7%,162/1271),Klebsiella pneumoniae(8.3%,105/1271),Haemophilus influenzae(7.4%,94/1271),Pseudomonas aeruginosa(6.2%,79/1271),Burkholderia cepacia(5.3%,67/1271)and Escherichia coli(3.7%,47/1271).The main pathogens in the intensive care unit(ICU)were gram-negative bacteria(80.1%,428/534),among which Acinetobacter baumannii was the most common(3.7%,199/534).The main pathogens in the non-ICU were gram-positive bacteria(70.8%,522/737).The detection rates of methicillin-resistant Staphylococcus aureus(MRSA)were 45.1%(23/51)in the ICU and 43.2%(48/111)in the non-ICU,respectively.The detection rates of penicillin-resistant Streptococcus pneumoniae(PRSP)were 10.9%(6/55)in the ICU and 18.5%(76/411)in the non-ICU,respectively.The detection rates of carbapenem-resistant Klebsiella pneumoniae(CRKP)were 57.3%(43/75)in the ICU and 33.3%(10/30)in the non-ICU,respectively.The detection rate of carbapenem-resistant Pseudomonas aeruginosa(CRPA)in the ICU was higher than that in the non-ICU(49.1%(27/55)vs 25.0%(6/24)),and the difference was statistically significant(χ^(2)=3.98,P=0.046).Eight strains(17.0%)of carbapenem-resistant Escherichia coli were detected,and 164 strains(76.6%)of carbapenem-resistant Acinetobacter baumannii were detected.Seventy-eight Haemophilus influenzae isolates were isolated from non-ICU,and the resistance rate to ampicillin was 57.4%(54/94).Burkholderia cepacia isolates were all isolated from ICU,and the resistance rates to piperacillin-tazobactam,levofloxacin,ciprofloxacin and compound sulfamethoxazole were 13.4%(9/67),3.0%(2/67),0(0/67)and 9.0%(6/67),respectively.Conclusions Streptococcus pneumoniae is still the most common pathogen in pediatric patients with lower respiratory tract infection.Gram-negative bacilli are the main pathogens in pediatric patients with lower respiratory tract infection in the ICU.The dection rates of MRSA,PRSP and carbopenem-resistant gram-negative bacilli are high.And the resistance rate of Haemophilus influenzae to ampicillin is also high.The clinical empirical treatment should be determined according to different clinical background.
作者
田鹤
成怡冰
朱庆雄
李双杰
陈敏霞
佟健宁
单庆文
王芳
曾玫
Tian He;Cheng Yibing;Zhu Qingxiong;Li Shuangjie;Chen Minxia;Tong Jianning;Shan Qingwen;Wang Fang;Zeng Mei(Department of Infectious Diseases,National Children′s Medical Center,Children′s Hospital of Fudan University,Shanghai 201102,China;Department of Infectious Diseases,Children′s Hospital Affiliated to Zhengzhou University(Henan Children′s Hospital),Zhengzhou 450018,China;Department of Infectious Diseases,Children′s Hospital of Jiangxi Province,Nanchang 330046,China;Department of Hepatology,Hunan Children′s Hospital,Changsha 410007,China;Department of Infectious Diseases,Guangzhou Women and Children′s Medical Center,Guangzhou 510623,China;Department of Pediatric,Gastroenterology and Infectious Diseases,Qingdao Women and Children′s Hospital,Qingdao 266520,China;Department of Pediatrics,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《中华传染病杂志》
CAS
CSCD
2022年第1期20-27,共8页
Chinese Journal of Infectious Diseases
关键词
细菌
抗药性
下呼吸道感染
肺泡灌洗液
儿童
Bacteria
Drug resistance
Lower respiratory tract infection
Alveolar lavage fluid
Children
