儿童社区获得性肺炎致病菌及其耐药性分析  

Analysis of the Characteristics of Pathogenic Bacteria and Drug-resistant in Children with Community-acquired Pneumonia

作　　者：陈传贵[1] 陈光福[1] 富国华[1] 

机构地区：[1]广东省深圳市第二人民医院儿科,广东深圳518035

出　　处：《河北医学》2008年第9期1077-1080,共4页Hebei Medicine

摘　　要：目的:探讨儿童社区获得性肺炎的致病菌特征及耐药性,为指导临床合理使用抗菌药物,减少耐药菌。方法:对706例儿童社区获得性肺炎儿童的痰标本进行培养并做药敏试验。结果:706例标共本检出致病菌161株,总阳性率为22.8%,其中革兰阳性菌、革兰阴性菌和真菌分别14.9%、69.6%、15.5%。主要致病菌依次为肺炎克雷伯菌39株、真菌25株、大肠埃希菌23株、金黄色葡萄球菌21株,鲍曼不动杆菌15株,阴沟杆菌9株,铜绿假单胞菌7株。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs)率分别为39.2%和58.0%。肺炎克雷伯菌和大肠埃希菌对氨苄西林耐药分别为100%、52.2%,对第三代头孢耐药率超过30%,未检出对亚胺培南耐药。金黄色葡萄球菌对青霉素和和红霉素耐药率分别为90.5%、47.6%。结论:儿童社区获得性肺炎致病菌病原菌以革兰阴性菌为主,这些细菌对常用的抗生素产生了较高的耐药性。痰培养结果与临床结合有利于指导用药,减少细菌耐药率。Objective： To investigate the characteristics of pathogenic bacteria and drug-resistant in children with community-acquired pneumonia, to provide reasonable use of antibacterial agents and reduce drug-resistant rate. Methods： 706 samples of sputum from children with community-acquired pneumonia were collected and cultured for aerobic bacteria, followed by antibiotic susceptibility testing. Results： 161 bacterial strains were isolated from 706 children with community-acquired pneumonia. Cultured was positive in 161 （22.8%） of those 706 patients. Of them Gram-positve bacteria, Gram-negative bacteria and mycosis were accounted for 14.9%, 69.6%, 15.5%. Main pathogenic bacteria were KlebsieUa pneumoniae （ 39 strains ） , Mycosis （ 25 strains ） , Escherichia coli （ 23 strains ）, Staphylococcus aureus （ 21 strains ） , Acinetobacter baumannii （ 15 strains ） , Enterobacter cloacae （ 9 strains ） ; Pseudomonas aeruginosa （ 7strains ） in turn. The detection rates of extended spectrum beta-lactamases producing salmonella （ ESBLs） were 64.1 % ,39. 1% respectively in Klebsiella pneumoniae and Escherichia coli . 100% of Klebsiella pneumoniae strains and 52.2% of Escher/chia coli strains were resistance to ampicilin, the third eneratcephalosporins-resistan were more than 30% and there were no resistance to imipenem in Ktebsiella pneumoniae and Esche-richia coli. 90.5%, 47.6% of Staphylococcus aureus strains were resistance to penicillin and erythromycin. Conclusions： There were more infected rates in the children with community -acquired pneumonia suffered from Gram-negative bacteria than Gram-posidve one. There were higher drug-resistant rate to common used anti-bacterial agents in these pathogenic bacteria. It is of guiding significance for medicine application if combining the result of sputum culture with clinical cases to reduce drug-resistant rate.

关 键 词：社区获得性肺炎 细菌培养/痰 耐药性 

分 类 号：R446.5[医药卫生—诊断学]