婴幼儿下呼吸道感染痰检细菌分布和耐药分析  

Analysis of Bacterial Distribution and Drug Resistance in Induced Sputum of Infants with Lower Respiratory Tract Infection

作　　者：陈和斌[1] 陆小霞[1] 夏维[2] 孙继民[3] 

机构地区：[1]武汉市儿童医院呼吸科,武汉430016 [2]武汉市儿童医院检验科,武汉430016 [3]武汉市儿童医院PICU,武汉430016

出　　处：《实用儿科临床杂志》2011年第22期1725-1727,1733,共4页Journal of Applied Clinical Pediatrics

摘　　要：目的了解武汉地区3岁以下婴幼儿下呼吸道感染病原菌的分布及耐药情况,为临床合理选用抗生素提供依据。方法选择2008年2月-2009年1月本院呼吸科收治的3岁以下下呼吸道感染婴幼儿4 013例,患儿用药前无菌操作取诱导痰标本,标本送细菌培养。药物敏感试验采用琼脂扩散敏感试验(K-B法)。结果共检出细菌3 938株,检出率为98.13%。检出的革兰阳性细菌由多到少依次为肺炎链球菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌,其中肺炎链球菌对β内酰胺类抗生素的平均耐药率为47.13%。革兰阴性菌依次为大肠埃希菌、肺炎克雷伯菌、流感嗜血杆菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌、产气肠杆菌、大肠杆菌及黏质沙雷菌等,其中大肠埃希菌和肺炎克雷伯菌主要产超广谱β内酰胺酶,其产酶率分别为54.12%和46.96%;流感嗜血杆菌则主要产β-内酰胺酶,产酶率为65.06%。结论婴幼儿痰检符合临床诊疗表现的具有病原学诊断意义的致病菌以革兰阴性菌为主,其中产酶耐药者占40%以上,临床首次经验性选药应该充分考虑到这一特点,特别是重症患者抗生素的选用更应该有效覆盖到可能的耐药菌,以降低首次不适当用药的概率,提高重症患儿的治疗有效率和生存率。Objective To investigate the distribution of pathogens and their antibiotic resistance in children with lower respiratory tract infection in Wuhan area, so as to provide proper instructions for clinical application of antibiotics. Methods Induced sputum was extracted from 4 013 cases of hospitalized children, and microbial sensitivity test was performed with agar diffusion sensitivity test. Results From all the 4 013 patients, 3 938 bacterial strains were isolated, and the detection rate of pathogen was 98.13%. The gram - positive bacteria in sequence were streptococcus pneumoniae, staphylococcus aureus and coagulase negative staphylococci. The average resistance rate of streptococcus pneumoniae to β - lactam antibiotics was 47.13%. The gram - negative bacteria in sequence were escherichia coli, klebsiella pneumoniae,haemophilus influenzae ,pseudomonas aeruginosa, enterobacter cloacae, acinetobacter baumannii, enterobacter aerogenes, escherichia cob and sen＇aria marcescens. The main bacterium which could produce extended spectrum β - lactamases were escherichia coli and klebsiella pneumoniae, and the rates of enzyme production were 54.12% and 46.96%, respectively. Haemophilus influenzae mainly produced β -lactamase,and its rate of enzyme production was 65.06%. Conclusions In the sputum culture of infants with lower respiratory tract infection, the main pathogenic microbes which had diagnostic significance were gram - negative bacteria, among which β- lactamases producing strains were above 40%. It should be considered in the empirical use of antimicrobial, especially in severe patients to reduce the risk of irrational use of antibiotics and improve both the therapy and survival rate of the severely ill children.

关 键 词：下呼吸道感染 细菌分布 耐药分析 婴幼儿 

分 类 号：R725.6[医药卫生—儿科]