儿童社区与院内获得性肺炎的细菌病原构成及其耐药性对比研究  

Comparative studies on the composition and antibiotic-resistance of pathogenic bacteria between children with community-acquired and hospital-acquired pneumonia

作　　者：王喆[1] 季伟[1] 郭红波[1] 陶云珍[1] 丁云芳[1] 

机构地区：[1]苏州大学附属儿童医院呼吸科,215003

出　　处：《中华预防医学杂志》2011年第3期211-216,共6页Chinese Journal of Preventive Medicine

基　　金：苏州社会发展科技计划（SS0702）

摘　　要：目的 探讨儿童社区获得性肺炎（community-acquired pneumonia,CAP）与院内获得性肺炎（hospital-acquired pneumonia,HAP）细菌病原构成及耐药性的差异.方法 选取在苏州大学附属儿童医院2008年1月至12月间住院治疗并且痰细菌学培养阳性的241例CAP和116例HAP患儿,采用传统手工方法鉴定分离细菌,纸片扩散法（K-B法）进行药敏试验.采用x2检验或Fisher精确概率法进行统计学检验,P＜0.05为差异有统计学意义.结果 CAP中肺炎链球菌和流感嗜血杆菌分别占42.2%（106/251）和12.4%（31/251）;HAP中肠杆菌科及非发酵革兰阴性杆菌占88.2%（127/144）.CAP未检出耐甲氧西林金黄色葡萄球菌,而HAP检出率为66.7%（8/12）.肺炎克雷伯杆菌对头孢他啶、头孢吡肟、氨曲南、头孢哌酮舒巴坦、哌拉西林＋他唑巴坦的院内耐药率高于社区感染的1.5倍以上,分别为37.5%（6/16）和75.6%（31/41）、37.5%（6/16）和78.0%（32/41）、50.0%（8/16）和90.2%（37/41）、12.5%（2/16）和51.2%（21/41）、12.5%（2/16）和56.0%（23/41）;阴沟肠杆菌对庆大霉素、SMZ＋TMP、头孢哌酮舒巴坦的院内耐药率高于社区感染的1.5倍以上,分别为0和63.6%（7/11）、20.0%（1/5）和63.6%（7/11）、0和54.5%（6/11）;铜绿假单胞菌对亚胺培南、氨曲南、头孢哌酮的院内耐药率高于社区感染的1.5倍以上,分别为0和46.7%（7/15）、9.1%（1/11）和60.0%（9/15）、18.2%（2/11）和80.0%（12/15）;鲍曼不动杆菌对庆大霉素、阿米卡星、头孢他啶、头孢吡肟、头孢哌酮的院内耐药率高于社区感染的1.5倍以上,分别为0和50.0%（9/18）、0和38.9%（7/18）、0和55.6%（10/18）、0和50.0%（9/18）、33.3%（2/6）和94.4%（17/18）.大肠埃希菌和肺炎克雷伯杆菌的超广谱β内酰胺酶（ESBLs）检出率在CAP和HAP中分别为84.6%（11/13）、93.3%（14/15）（x2=0.553,P＞0.05）和81.3%（13/16）、95.1%（39/41）（x2=2.767,P＞0.05）,未显示Objective This research was to explore the difference between children with community-acquired pneumonia （CAP） and hospital-acquired pneumonia （HAP） in the composition and antibiotic-resistance of pathogenic bacteria. Methods 241 CAP and 116 HAP with positive sputum culture who were hospitalized from January to December in 2008 in Children＇s Hospital Affiliated to Suzhou University were selected in this study. The bacteria were identified by traditionally manual method and antibiotic sensitivity tests were performed by K-B method. The chi-square or Fisher＇s exact test were used for statistical test. Results In 241 CAP, Streptococcus pneumoniae and haemophilus influenza accounted for （42.2%, 106/251） and（12.4% ,31/251 ） infection, respectively; however in 116 HAP, Enterobacteriaceae and Non-fermenters accounted for （88. 2% ,127/144）. In addition,methicillin-resistant Staphylococcus aureus weren＇t isolated, however, its detection rate was 66.7% in HAP. The drug resistance was 1.5 times higher in HAP than that in CAP for several types of antibiotics, such as ceftazidime （37.5% （6/16） vs 75.6% （31/41））, cefepime （37.5% （6/16）vs 78.0%（32/41））, aztreonam（50. 0% （ 8/16 ） vs 90. 2%（37/41））, cefoperazone/sulbactam （12.5%（2/16） vs 51.2%（21/41）） and piperacilin/tazobactam （12. 5% （2/16） vs 56. 0% （23/41））. Klebsiella pneumoniae isolated from HAP had higher drug resistance than that isolated from CAP against some antibiotics,for example,gentamicin（0 vs 63.6% （7/11 ） ） ,SMZ＋TMP（20.0%（1/5）vs 63.6%（7/11）） and cefoperazone/sulbactam（0 vs 54.5% （6/11） ）. We also found Enterobacter cloacae isolated from HAP showed high drug resistance than that isolated from CAP against imipenem（0 vs 46.7%（7/15））, aztreonam（9.1%（1/11）vs 60.0%（9/15）） and cefoperazone（18.2%（2/11 ） vs 80. 0% （12/15）） and Pseudomonas aeruginosa from HAP had higher resistance than that from CAP against gentamicin （0 vs 50

关 键 词：儿童 社区获得性感染 交叉感染 肺炎 抗药性 纸片扩散抗菌试验 

分 类 号：R446.5[医药卫生—诊断学]